What are the signs and symptoms of a baby seizure? Extensor thrust. This procedure cools the babys brain and body to prevent brain damage. 2008 May 6. The age at which gross motor milestones are achieved in typically developing children include head control at age 2 months, rolling at age 4 months, sitting at age 6 months, and walking at age 1 year. When bent, they become mirror images of one another. 2009 Mar. %PDF-1.7 % In these instances, the most apparent early sign of Cerebral Palsy is developmental delay. 22(2):308-315. Support is needed to control posture and provide secure base and for some children standing frames are ideal. Clin Obstet Gynecol. Asymmetrical tonic neck reflex elicited by rotating the head to one side causing ipsilateral extension of the . Impaired or delayed fine motor skills are an indicator of possible Cerebral Palsy. Hoda Z Abdel-Hamid, MD Associate Professor, Department of Pediatrics, University of Pittsburgh School of Medicine; Director of EMG Laboratory and Neuromuscular Program, Director of Pediatric MDA Clinic, Division of Child Neurology, Childrens Hospital of Pittsburgh, University of Pittsburgh Medical Center By contacting MyChild or Stern Law, PLLC in any way, including by a link from this website, you certify that you agree to our Terms of Use, Privacy Policy and Disclaimer and wish to be contacted regarding your inquiry. 0000003141 00000 n Various primitive reflexes are being assessed in CP 0000001729 00000 n 304(9):976-82. Read on to learn more about the signs and symptoms of a baby seizure and treatment. 0000006550 00000 n 2008 Dec 14. 91(3):254-8. and transmitted securely. [QxMD MEDLINE Link]. Ancel PY, Livinec F, Larroque B, Marret S, Arnaud C, Pierrat V, et al. National Library of Medicine Gross motor function may be impaired by abnormal muscle tone, especially hypertonia or hypotonia. When a baby experiences a tonic seizure, they may: Clonic means twitching or jerking, so when a baby has a clonic seizure, they may display repeated, uncontrolled jerking muscle movements. Standardized cognitive and educational testing and a current individualized education plan can be used to determine whether speech therapy, occupational therapy, and physical therapy referrals are needed, if not already in place. Unable to load your collection due to an error, Unable to load your delegates due to an error. Jan 25 2013. 355(7):685-94. A child with Cerebral Palsy may demonstrate any combination of these signs. The longer the period of hypotonia before hypertonia, the greater the likelihood that the hypertonia will be more severe. [QxMD MEDLINE Link]. 2004 Mar. If the delivery was traumatic, or if significant risk factors were encountered during pregnancy or birth, doctors may suspect Cerebral Palsy immediately. N Engl J Med. Dabney KW, Lipton GE, Miller F. Cerebral palsy. Pseudocolpocephaly and decreased volume of the white matter posteriorly were consistent with periventricular leukomalacia. Dysarthria is broken into the following subgroups: Drooling is another sign of Cerebral Palsy that results from muscles in the face and mouth not being able to properly control coordination. Prospective follow-up of primitive reflex profiles in high-risk infants: clues to an early diagnosis of cerebral palsy. Original Editor - Verbena Bottinias pat of ICRC Cerebral Palsy Content Development Project, Top Contributors - Naomi O'Reilly, Kim Jackson, Admin, WikiSysop, Simisola Ajeyalemi, Amrita Patro, Olajumoke Ogunleye, Wendy Walker and Oyemi Sillo. Again this might help such a child to use the eyes and two hand for a task.[3]. Pediatric Research - THE SYMMETRIC TONIC NECK REFLEX (STNR) AS A NORMAL . London, United Kingdom: MacKeith Press; 2000. Intrapartum hypoxic-ischemic cerebral injury and subsequent cerebral palsy: medicolegal issues. Some cognitive impairment is found in about 28% of these patients. J Pediatr Health Care. New directions in the outcome evaluation of children with cerebral palsy. Infection and injury are common causes of brain seizures. However, these signs may resemble usual, everyday movements and may be difficult to spot. Pediatrics. [QxMD MEDLINE Link]. 2023 Jan 28;20(3):2322. doi: 10.3390/ijerph20032322. Children with cerebral palsy may have an early period of hypotonia followed by hypertonia. Intention tremors, where a task becomes more difficult as it gets closer to completion, is one such sign. Stanley F, Blair E, Alberman E. Cerebal Palsies: Epidemiology and Causal Pathways. Cerebral Palsy is caused by a brain injury or brain abnormality that interferes with the brain cells responsible for controlling muscle tone, strength, and coordination. Life expectancy in severe cerebral palsy. A nonepileptic seizure does not involve abnormal brain activity. 2022 Apr 7;10:837909. doi: 10.3389/fped.2022.837909. Handling the young child with cerebral palsy at home. Older children may also show some of the signs and symptoms of retained ATNR discussed above. [Full Text]. Tran NN, Desai J, Votava-Smith JK, Brecht ML, Vanderbilt DL, Panigrahy A, Mackintosh L, Brady KM, Peterson BS. 117(3):828-35. [QxMD MEDLINE Link]. Trost JP, Schwartz MH, Krach LE, Dunn ME, Novacheck TF. Philadelphia: FA Davis Company. Bethesda, MD 20894, Web Policies Pediatrics. However, they do know it occurs in some babies that do not receive enough oxygen.Learn more about cerebral palsy here. Hoda Z Abdel-Hamid, MD is a member of the following medical societies: American Academy of Neurology, American Association of Neuromuscular and Electrodiagnostic Medicine, Child Neurology SocietyDisclosure: Nothing to disclose. Establishing the diagnosis of cerebral palsy. Elsevier Health Sciences; 1997. An abnormal electrical discharge in the brain causes a seizure. Zhonghua Liu Xing Bing Xue Za Zhi. Arch Dis Child. The combined examination is also useful in developed countries because many developmental disorders such as cerebral palsy appear in nonrisk groups whereas others are not detected by metabolic screening programs. By this time the typical child has good trunk control, balance in sitting and hip mobility. Growth disturbance is often noted in children with cerebral palsy, especially failure to thrive. [QxMD MEDLINE Link]. The child may present as either hypotonic or, more commonly, hypertonic with either decreased or increased resistance to passive movements, respectively. Pediatrics. American College of Obstetricians and Gynecologists, American Academy of Pediatrics. government site. Hyperreflexia are excessive reflex responses that cause twitching and spasticity. Do not provide confidential information. In other instances, the child can't identify which hand or leg to use, causing him to hesitate in movements. A baby begins experiencing ATNR while still in the womb, and this reflex can start as early as 18 weeks into your pregnancy. Arcilla, C., Vilella, R. Tonic Neck Reflex. Altered postural tone (hypertone, low tone or fluctuating tone), common in children with Cerebral Palsy, affects their ability to organize and control voluntary movements effectively, producing abnormal patterns that compromise their performance during daily live activities and increase the risk of secondary complications such as contractures and deformities, pressure sores, briefing difficulties, swallowing impairments, pain etc. Tonic neck reflex. 2009 Jan 21. Because Cerebral Palsy is a group of conditions, signs and symptoms vary from one individual to the next. These reflexes are crucial because they help your baby to survive and thrive., ATNR should only occur during the first few months after birth without any sequential order. N Engl J Med. Vincer MJ, Allen AC, Joseph KS, Stinson DA, Scott H, Wood E. Increasing prevalence of cerebral palsy among very preterm infants: a population-based study. Asymmetrical posture means the right and left limbs will not mirror one another. Learn more about epilepsy in children here. Full integration means that when your baby is awake, they will not show the fencers pose when they turn their head lying down. CD004661. extended while a patient is lying on his or her back, the legs and arms also extend, and the back and neck arch. Proposed definition and classification of cerebral palsy, April 2005. Blackmore AM, Boettcher-Hunt E, Jordan M, Chan MD. https://www.ncbi.nlm.nih.gov/books/NBK559210/, https://www.cdc.gov/ncbddd/cp/causes.html, https://www.epilepsy.com/learn/types-seizures/clonic-seizures, https://www.epilepsy.com/living-epilepsy/epilepsy-and/parents-and-caregivers/about-newborns-and-infants/diagnosis-infant-seizures, https://www.ncbi.nlm.nih.gov/books/NBK542173/, https://www.ninds.nih.gov/Disorders/Patient-Caregiver-Education/Fact-Sheets/Febrile-Seizures-Fact-Sheet, https://neoreviews.aappublications.org/content/19/8/e467, https://www.aafp.org/afp/2012/0115/p149.html, https://www.ncbi.nlm.nih.gov/books/NBK554535/, https://www.epilepsy.com/article/2014/3/medications-neonatal-seizures-and-infantile-spasms, https://www.ilae.org/files/ilaeGuideline/Classification-of-seizures---modification-for-neonates-epi.16815-2021-02.pdf?fbclid=IwAR3v7l4Lh0wCzjdKv7pLXbzWca5w6heildq_uC7Fgi-8bJ-3HsNcaXH2cJI, https://www.epilepsy.com/learn/seizures-youth/about-newborns-and-infants/seizures-newborns, Cardiovascular health: Insomnia linked to greater risk of heart attack. If a baby has a seizure and struggles to breathe or their symptoms last longer than 5 minutes, call 911 or take them to an emergency room. 8600 Rockville Pike Knee Flexion and extension with valgus or varus stress occur. 2021. The American Journal of Occupational Therapy: Official Publication of the American Occupational Therapy Association: Role of the asymmetrical tonic neck reflex in hand visualization in normal infants., Archives of Medical Science: Persistence of primitive reflexes and associated motor problems in healthy preschool children., Australasian Journal of Early Childhood: Retained primary reflexes in pre primary-aged Indigenous children: The effect on movement ability and school readiness., Handbook of Neurolinguistics: Brain Lateralization across the Life Span., Integrated Learning Strategies: ATNR: Studies Show 50% of Kids with a Retained ATNR Primitive Reflex Struggle with Dyslexia., International Journal of Environmental Research and Public Health: Primitive Reflex Activity in relation to the Sensory Profile in Healthy Preschool Children., International Journal of Neuroscience: Asymmetric tonic neck reflex and symptoms of attention deficit and hyperactivity disorder in children., JOURNAL OF NEUROPHYSIOLOGY: POSTURAL REFLEXES AND GRASP PHENOMENA IN INFANTS., Journal of Speech, Language and Research: Developmental Language Disorder and Uninhibited Primitive Reflexes in Young Children., Optometrists Network: What are Retained Primitive Reflexes?, Physical Therapy and Rehabilitation Science: Primitive Reflex Integration in Intensive Physical therapy and Gross Motor Function in Children with Cerebral Palsy: A Case Report., PLoS ONE: Biomechanics of fencing sport: A scoping review., Rhythmic Movement Training International: Asymmetrical Tonic Neck Reflex., Stanford Medicine: Neuro/Reflexes.. 0000008702 00000 n Learn more about meningitis in babies here. The fencers pose is a motion where your baby appears to be challenging an opponent. Allen MC, Capute AJ. These findings are most likely the sequelae of a neonatal insult (eg, periventricular leukomalacia with a superimposed left-sided cerebral infarct). When a baby has hydrocephalus, cerebrospinal fluid (CSF) applies pressure on the brain. Most patients with spastic quadriplegic cerebral palsy have some cognitive impairment and demonstrate the following classic physical presentations: All limbs affected, either full-body hypertonia or truncal hypotonia with extremity hypertonia, Multiple medical complications (see Complications under Prognosis), Legs generally affected equally or more than arms, Categorized as double hemiplegic if arms more involved than legs. persistent palmar grasp, Moro, asymmetric tonic neck reflexes. There are many causes of seizures in babies. 61(3):128-134. Mattern-Baxter K. Effects of partial body weight supported treadmill training on children with cerebral palsy. The impairment of coordination and control fall under the following types: Certain abnormal reflexes may also indicate Cerebral Palsy. xref Seizure Characteristics and Background Amplitude-Integrated Electroencephalography Activity in Neonatal Rats Subjected to Hypoxia-Ischemia. Most experts agree; the earlier a Cerebral Palsy diagnosis can be made, the better. Papile LA, Burstein J, Burstein R, Koffler H. Incidence and evolution of subependymal and intraventricular hemorrhage: a study of infants with birth weights less than 1,500 gm. Definite hand preference before age 1 year is a "red flag" for possible hemiplegia. MeSH . Signs are clinically identifiable effects of brain injury or malformation that cause Cerebral Palsy. Although often seen in children with cerebral palsy (CP), it is an uncommon finding in term neonates and infants. If you turn . 96(6):505-12. However, while this reflex presents with signs such as eye-rolling, lip-smacking, and leg pedaling movements, these are normal movements, particularly in newborns. 30% (161/532) 4. Muthusamy K, Recktenwall SM, Friesen RM, Zuk J, Gralla J, Miller NH, et al. Heart failure: Could a low sodium diet sometimes do more harm than good? 21(1):12-22. 382 0 obj <> endobj The 2003 American Academy of Neurology (AAN) practice parameter suggests screening for the following potential cerebral palsyassociated deficits at the initial assessment: 0000038570 00000 n When it doesnt happen, your child cant track a horizontally passing object past the nose without stopping at the midline. Semin Pediatr Neurol. Elia AE, Bagella CF, Ferr F, Zorzi G, Calandrella D, et al. 2nd ed. Community Support: The Role of the Federal Government, Community Support and Funding: The Role of State and Local Government, Terms of Use, Privacy Policy and Disclaimer. All rights reserved. Melillo R, Leisman G, Machado C, Machado-Ferrer Y, Chinchilla-Acosta M, Kamgang S, Melillo T, Carmeli E. Front Neurol. Sitting becomes a truly functional position for play when a child is about 8-9 months old. Neurology. Cerebral palsy among term and postterm births. Medications for neonatal seizures and infantile spasms. 0000038716 00000 n Rouse DJ, Hirtz DG, Thom E, Varner MW, Spong CY, Mercer BM, et al. It is quick and easy to perform, both in nonhospital environments and in underdeveloped countries, where time and specific recourses are limited. Different muscle control impairments can combine to cause limbs to be perpetually extended, contracted, constantly moving in rhythmic patterns or jerking spastically. Gross motor function Answer. The brain injury or malformation that caused Cerebral Palsy impairs the ability of the central nervous system to coordinate muscle movement. Learn more here. If legal services are sought, individuals will be directed to Stern Law, PLLC and ONLY when an attorney-client relationship has been established as explained below, will legal services be provided by Stern Law, PLLC, and/or other law firms with which they may affiliate. One should not wait until the child with Cerebral Palsy has developed all these abilities before allowing the child to sit and play and, of course, some children with Cerebral Palsy many never attain independent sitting. Bookshelf Another reason this warrants a test is troubled visual tracking. By clicking Subscribe, I agree to the WebMD, Smart Grocery Shopping When You Have Diabetes, Surprising Things You Didn't Know About Dogs and Cats, Smoking Pot Every Day Linked to Heart Risks, Artificial Sweetener Linked to Heart Risks, FDA Authorizes First At-Home Test for COVID and Flu, New Book: Take Control of Your Heart Disease Risk, MINOCA: The Heart Attack You Didnt See Coming, Health News and Information, Delivered to Your Inbox, Symptoms of Retained Asymmetric Neck Tonic Reflex. For example, a baby in a sitting position would normally have both legs in front. Retained Primitive Reflexes and Potential for Intervention in Autistic Spectrum Disorders. MNT is the registered trade mark of Healthline Media. The clinical significance of asymmetric tonic neck reflex, Moro, palmar grasp, plantar grasp, Galant, Babinski, Rossolimo, crossed extensor, suprapubic extensor, and heel reflex, alone or in combination, as well as their contribution to the early diagnosis and differential diagnosis of cerebral palsy, have been demonstrated in a number of studies. For example, if the child is habitually in an abnormally straight or extended position in lying (Fig.1 Global Pattern of Extension) it may be helpful to put him into a more bent or more flexed, symmetrical position. [QxMD MEDLINE Link]. They may do this in the emergency room or as a separate appointment. 0000016037 00000 n [QxMD MEDLINE Link]. The Primitive Reflex Profile was studied in 53 cerebral palsied patients to assess both the feasibility of its administration and its usefulness in discriminating functional levels of ambulation. The PubMed wordmark and PubMed logo are registered trademarks of the U.S. Department of Health and Human Services (HHS). Physio is mostly used for dystonic cerebral palsy and hand, focal and generalised dystonia. As a babys brain and body develop, they are expected to reach developmental milestones. Good positioning includes some basic general principles: It is very important to remember that children with Cerebral Palsy may manifest with a variety of different clinical features, for example children with spastic quadriplegia can show global pattern of extension or global pattern of flexion or asymmetric postures, therefore the general principles mentioned above should be adjusted to the specific positions useful to modify/improve the childs pattern of posture and movement. Smaller children or older children with severe involvement and limited ability to move should spend their day in a variety of positions including on the floor and be encouraged to move about freely [3]. Any medical information published on this website is not intended as a substitute for informed medical advice and you should not take any action before consulting with a healthcare professional. Cognitive impairment is present in approximately 30% of spastic diplegic patients. The Correlation between Residual Primitive Reflexes and Clock Reading Difficulties in School-Aged Children-A Pilot Study. that side stiffen and extend. Signs of oral motor function impairment include, but are not limited to difficulty with: Speech requires proper intellectual and physical development. To prepare for the EEG, a doctor places metal discs on the babys head that detect and record their brains electrical impulses. 13% (69/532) 3. Am J Obstet Gynecol. 2009 May. The https:// ensures that you are connecting to the View Peds.docx from NUR 222 222 at Mohave Community College. If you stimulate a young baby's nervous system in certain ways you can produce responses known as primitive reflexes, and the asymmetrical tonic neck reflex is one of these. [QxMD MEDLINE Link]. 2010 Dec. 30(8):840-5. Dev Med Child Neurol. Edwards P, Sakzewski L, Copeland L, Gascoigne-Pees L, McLennan K, Thorley M, et al. Its an important type of reflex that helps your baby move through the birth canal during vaginal birth. The frequency of asymmetrical skull deformity was analysed and related to the Gross Motor Function Classification System (GMFCS), postural abnormalities, and deformities. A high incidence of sensorineural hearing loss is reported. Take note, though, that not all occupational therapists believe in the connection between developmental delays and the presence of retained ATNR. The positions should be varied and changed frequently. Associative conditions, such as sensory impairment, seizures, and learning disabilities that are not a result of the same brain injury, occur frequently with Cerebral Palsy. If necessary, doctors may control seizures in babies with anticonvulsant medication, including: If the seizures are due to a lack of oxygen, doctors may administer hypothermic treatment. Symptoms, on the other hand, are effects the child feels or expresses; symptoms are not necessarily visible. Sun X, Xue F, Wen J, Gao L, Li Y, Jiang Q, Yang L, Cui H. Front Pediatr. 0000004791 00000 n For example good proximal stability of the trunk in sitting promotes selective movements of the upper limbs for playing, writing, eating etc. How Viagra became a new 'tool' for young men, Ankylosing Spondylitis Pain: Fact or Fiction. As the head is turned, the arm and leg on the same side will extend, while the opposite limbs bend. Would you like email updates of new search results? Semin Pediatr Neurol. 2004 Feb;25(2):127-30. Conde-Agudelo A, Romero R. Antenatal magnesium sulfate for the prevention of cerebral palsy in preterm infants less than 34 weeks' gestation: a systematic review and metaanalysis. Neonatal MRI to predict neurodevelopmental outcomes in preterm infants. 0000039610 00000 n Niemuth M, Kster H, Simma B, Rozycki H, Rdiger M; European Society for Paediatric Research (ESPR) Neonatal Resuscitation Section Writing Group; Solevg AL. Benefits Physio can improve movement and function Its success can be largely within your control Risks The attorney responsible for this Website is Kenneth A. Stern of the law firm, Stern Law, PLLC, Depending on your child's condition and progress, they may recommend evaluation by an occupational therapist.. For example, treatment will differ if a baby has epilepsy or is recovering from meningitis. Perlman JM. Positioning should be changed often to avoid pressure areas, to prevent stiffness and contractures and to allow the child to experience movement in different positions. See Rehabilitation and Cerebral Palsy. Pediatr Phys Ther. ATNR presents as consistent, one-sided movements of the body that go together with proper hand-eye harmonization. 2006 Feb. 48(2):90-5. Call 911, or take the baby to an emergency room if they are: Seizures are the most common neurological emergency in the first 4 weeks of a babys life. Babies may demonstrate this reflex up to 9 months old. https://profreg.medscape.com/px/getpracticeprofile.do?method=getProfessionalProfile&urlCache=aHR0cHM6Ly9lbWVkaWNpbmUubWVkc2NhcGUuY29tL2FydGljbGUvMTE3OTU1NS1jbGluaWNhbA==. Reflex Long-term survival for a cohort of adults with cerebral palsy. However, in some cases, your baby may need a year for ATNR to fully integrate. If a baby has cerebral palsy, they will find it difficult to control muscle. In moderate to mild cases of Cerebral Palsy, parents are often first to notice if the child doesnt appear to be developing on schedule. Eur J Paediatr Neurol. For example, hypertonic limbs can be too tight, or inflexible, to allow proper flexion and movement; whereas hypotonic limbs may be too loose to properly support a childs movements. If you log out, you will be required to enter your username and password the next time you visit. Spastic muscle imbalance often causes persistence of infantile coxa valga and femoral anteversion. Some signs will be more apparent when the child is under stress. The hip-joints are one area where this is often prominent in instances of Cerebral Palsy. 0000006780 00000 n 1997 Jun. [QxMD MEDLINE Link]. Epub 2021 Feb 23 doi: 10.1044/2020_JSLHR-19-00423. Symptoms of subtle seizures can include: Tonic means muscle stiffness. Cystic encephalomalacia in the left temporal and parietal regions, delayed myelination, decreased white matter volume, and enlarged ventricles can be seen in this image. Causes may include brain injury, infection, and underlying health conditions, such as cerebral palsy. Signs may appear as an infant begins to sit up and learn to move about. Pediatrics. [QxMD MEDLINE Link]. During this seizure, a parent or caregiver may notice the baby is clenching or twitching parts of its body, including: This refers to a type of seizure that starts with stiffening (tonic phase) followed by jerking (clonic phase). Stern Law, PLLC. Jones MW, Morgan E, Shelton JE, Thorogood C. Cerebral palsy: introduction and diagnosis (part I). [QxMD MEDLINE Link]. A systematic review of the effects of casting on equinus in children with cerebral palsy: an evidence report of the AACPDM. 2005 Aug. 47(8):571-6. N Engl J Med. Careers. Sometimes signs will seem to disappear when the child is asleep and muscles are relaxed. ", 12-Step Process for Diagnosing Cerebral Palsy, Prevention: The Role of the Medical Community, Prevention: The Role of the Research Community, Body Work and Massage Therapy Techniques Over 180 Modalities. Fine motor control encompasses many activities that are learned, and involves a combination of both mental (planning and reasoning) and physical (coordination and sensation) skills to master. Capute AJ, Accardo PJ, eds. Neurology of the Newborn. 2000 Jan;22(1):75-6. doi: 10.1016/s0887-8994(99)00110-1. It is often found in Cerebral Palsy that results in hypertonia and hypotonia. Early interventions and therapies have proven to help a child maximize their future potential. Pediatr Neurol. 2007 Oct. 49(10):781-90. [QxMD MEDLINE Link]. Cerebral Palsy is a symptom rather than a specific disease. 0000011394 00000 n Alicia T F Bazzano, MD, PhD, MPH Clinical Faculty, Division of Pediatric Emergency Medicine, Harbor/UCLA Medical Center; Chief Physician, Westside Regional Center Sometimes babies that have a fever or high body temperature may develop a febrile seizure. 2004 Mar. Association of cerebral palsy with Apgar score in low and normal birthweight infants: population based cohort study. Jones M & Gray S (2005) Assistive technology: Positioning and Mobility. 0000012279 00000 n Especially lying face down is a good position for a child to begin to develop control of the head, shoulders, arms, and hands, and also to stretch muscles in the hips, knees and shoulders. The reflex happens when a newborn turns their headbut you may not notice them. Dev Med Child Neurol. Spastic diplegic cerebral palsy includes the following classic physical presentations: Upper motor neuron findings in the legs more than the arms, Scissoring gait pattern with hips flexed and adducted, knees flexed with valgus, and ankles in equinus, resulting in toe walking, Learning disabilities and seizures less commonly than in spastic hemiplegia. (2020). Gait Disorders in Cerebral Palsy are commonly caused by lower limb spasticity and are the primary reason for orthopaedic consultations in CP patients. Washington, DC: American College of Obstetricians and Gynecologists; 2003. Learn about its causes, symptoms, and treatments here. Executing precise movements defines the category of fine motor function. A randomized, controlled trial of magnesium sulfate for the prevention of cerebral palsy. 0000007232 00000 n The diagnosis begins with a history of gross motor developmental delay in the first year of life. When the neck flexes, the arm flexes and the lower extremities extend. Ari S Zeldin, MD, FAAP, FAAN is a member of the following medical societies: American Academy of Neurology, American Academy of Pediatrics, Child Neurology SocietyDisclosure: Nothing to disclose.