[Types of diagnosis in the outpatient practice during the years 2006-2007]

In recent years significant increase of children reffered to neurological consultations has been observed. Also structure of diagnosis has changed fundamentally.

The aim of the study was to reveal differentiated structure of diagnosis in children reffered to neurology outpatient clinics during 2 years of their work.

Analysis included medical documentation of 18127 children aged 1-18 years, patients of Neurology Outpatient Clinic, Headache Outpatient Clinic and Neuromuscular Diseases Outpatient Clinic. These outpatient clinics are under supervision of Pediatric Neurology Clinic of Chair of Pediatric and Adolescent Neurology, Jagiellonian University.

The most numerous group consisted of children with paroxysmal events (11192, 61.74%). Diagnostics performed in outpatient clinics or during hospitalisation enabled to diagnose epilepsy in 52.42% and in remaining 9.31% other paroxysmal events: syncopes, tics, febrile convulsions, breath-holding spells, sleep disorders, night terrors, infantile masturbation and pseudoepileptic seizures. Second, in respect to number, group included children with headaches. Majority of them were reffered after exclusion of laryngological and ophtalmological causes of headaches. Specialist neuroimaging examinations, EEG examination and psychological consultations enabled to diagnose tension-type headaches in most cases, less often migraine and sporadically brain tumors were diagnosed. Another group enclose children with CNS lesions: fetopathies, congenital defects, cerebral palsy, metabolic and genetic disorders. Numerous group consisted of children with psychomotor retardation, emotional disorders, nocturnal enuresis, suspect of ADHD and scholar difficulties who needed longer development observation in order to establish final diagnosis. Group of children with neuromuscular diseases (375, 2.16%) was also differentiated. It consisted of children with muscular dystrophies and myopathies (50%), acquired peripheral mononeuropathies (post-traumatic, post-inflamatory and tunnel syndromes) and genetically determined and acquired polyneuropathies (45%) and also myasthenia and myasthenic syndromes (5%).

Analysis of two years work of three specialist outpatient clinics revealed differentiated causes of consultations of treated children. Paroxysmal events and necessity of initial differential diagnosis performance were main problems of their work. Fast increase in number of children with headaches, scholar difficulties and suspect of ADHD has been observed.