#13: Pediatric Neurology in Hyderabad: Expert Insights with Dr. Pranathi Gutta

8. Alternative Therapies for Epilepsy

Madhavi Adimulam: We know medications are often the first line of treatment for epilepsy. But you also specialize in other approaches, such as dietary therapies like the ketogenic diet. Can you explain how these alternative therapies work and when they might be appropriate for children with epilepsy?

Dr. Pranathi Gutta: For children with epilepsy, especially those who also have developmental delays or intellectual difficulties, it's crucial to investigate the underlying cause. Many conditions, like metabolic disorders, can contribute to both epilepsy and developmental challenges. If a treatable condition is identified, we often start with specific diets and therapies. If not, medication becomes the next step.

Madhavi Adimulam: So, it’s about taking a holistic approach and looking beyond just managing the seizures.

Dr. Pranathi Gutta: Precisely. For example, a child with phenylketonuria (PKU), which is an inborn error of metabolism, requires lifelong dietary modifications to avoid certain amino acids. In these cases, we collaborate with specialist dieticians to personalize their meal plans. We also have children who respond well to high doses of specific vitamins like B6 or B12 (methylcobalamin). We carefully determine the most suitable formulation and dosage, tailoring it to their individual biochemical needs.

The ketogenic diet is another alternative therapy we consider, especially for those with drug-resistant epilepsy. It’s a specialized, high-fat, low-carbohydrate diet that must be meticulously monitored, with every gram of food carefully measured. Even things like toothpaste and medications might need to be sugar-free. It's a demanding diet, but it can be remarkably effective in reducing seizures when implemented correctly.

Madhavi Adimulam: I remember a mother of a child with epilepsy who brought a special rescue medication to Ananya. She was incredibly anxious about her child having a seizure during therapy. We had to learn how to administer the medication if needed. It's definitely a challenging condition for both families and therapists.

Dr. Pranathi Gutta: I understand. Most people, understandably, don't know how to manage seizures. It's essential for therapists to have some basic first-aid training. The most important thing is not to panic. Place the child in the recovery position (on their side), and don't restrain them. Most seizures resolve within five minutes. Knowing what NOT to do is often more crucial than knowing what to do.

Madhavi Adimulam: That's a valuable point. Sometimes, knowing how to react calmly is the best way to help. Now, shifting gears a bit, you also work with children who have complex neurometabolic conditions.

9. Neurometabolic Conditions and Comprehensive Care

Madhavi Adimulam: Can you give us a brief overview of what these conditions are and how you collaborate with other specialists like metabolic specialists to provide comprehensive care?

Dr. Pranathi Gutta: Neurometabolic conditions are essentially chemical imbalances in the body that affect the brain. Around 80% of metabolic disorders have neurological symptoms, including developmental delays, epilepsy, and distinctive physical features (dysmorphic features). These disorders are genetically determined, often due to errors in the genetic code that lead to missing enzymes, inadequate substrates, or the buildup of toxic substances, ultimately damaging the nervous system.

There are specialists who focus on these conditions, known as metabolic specialists or inborn errors of metabolism specialists. Dr. Radha Ramadevi is a well-known expert in Hyderabad, and Dr. Anil Jallian, trained in Mumbai, also visits the city every three months.

Unfortunately, India lacks a universal newborn screening program for these disorders, although some private hospitals offer it. I strongly encourage parents to consider newborn screening, as early detection and intervention can prevent significant damage.

We conduct various tests, including metabolic screening, urine analysis, vitamin levels, thyroid function, and genetic testing to confirm the diagnosis. Treatment often involves lifelong diet modifications, vitamin supplementation, or specific medications.

Early diagnosis is vital. Of the 1,904 known metabolic disorders, 225 are treatable, and 75% of those present with epilepsy. Given the prevalence of consanguineous marriages in our region, these conditions are more common, making newborn screening even more critical.

Madhavi Adimulam: So these screenings can be life-changing, but you mentioned they're expensive. Why is that a barrier for some parents?

Dr. Pranathi Gutta: The reagents used in these tests are costly, making the overall screening expensive. However, we can often narrow down the possibilities based on the child's symptoms and family history, allowing us to target the most relevant tests first. We believe in empowering parents by providing them with all the information and options available so they can make informed decisions.

Madhavi Adimulam: That’s an important point - providing options and empowering parents. You know, I learned from a researcher at Johns Hopkins that even children with autism can have difficulties producing or absorbing certain vitamins. My own son, who has autism, was on 16 supplements when he was six years old. It was a bit of a challenge navigating that back then, but he showed significant improvements with supplementation.

Thankfully, today we have more accessible tests for vitamin deficiencies. But many parents are still unaware of the crucial role supplementation can play in their child's development. Perhaps this is something we can discuss further in a future podcast. For now, let's talk about another condition that often brings children to both your clinic and Ananya CDC: ADHD.

10. ADHD Diagnosis and Treatment

Madhavi Adimulam: How do you approach the diagnosis and treatment of ADHD in your practice?

Dr. Pranathi Gutta: We see children with ADHD from various backgrounds, including NICU graduates. Sometimes, there is no identifiable cause. When a child exhibits features of attention difficulties and impulsivity, we conduct a thorough developmental assessment. This usually involves evaluation by both a medical professional, who specializes in ADHD, and a psychologist. We gather information through school and parental interviews and ensure that the symptoms are present in at least two different settings to reduce bias, as there's no definitive diagnostic test for ADHD.

Most children with ADHD have typical intellectual abilities. Our initial focus is on behavior modification, using strategies to improve attention span, concentration, and reduce impulsivity. This often includes occupational therapy and behavior modification therapy.

For children over seven years old who struggle with sitting tolerance, especially in school settings, we might consider medication if therapies haven’t been effective enough. We start with a low dose of immediate-release medication, gradually adjusting to find the optimal dosage before transitioning to a sustained-release formulation. We closely monitor for any side effects and ensure regular follow-ups to assess the effectiveness of the medication.

Madhavi Adimulam: It sounds like a multi-faceted approach, combining both behavioral and medical interventions when necessary. Now, shifting our focus to communication, many parents come to Ananya concerned about their child’s speech and language development.

11. Speech and Language Development

Madhavi Adimulam: What is the link between neurology and speech and language development? Many neurological conditions like autism can impact children's speech and language development.

Dr. Pranathi Gutta: We've seen a significant increase in speech delays in children, even before the pandemic. It constitutes about 10-20% of my consultations. From a neurological perspective, putting aside environmental factors like screen time and social dynamics, autism spectrum disorder is a prominent factor in speech delays.

Attention difficulties and hyperactivity can also affect speech development. If a child isn't concentrating, they may struggle to learn to speak properly, potentially leading to learning disabilities like dyslexia, dysgraphia, or dyscalculia. Intellectual disabilities can also contribute to language difficulties.

Certain neurological conditions, such as cerebral palsy, can affect the muscles involved in speech, leading to articulation difficulties.

Developmental language disorder, where there's a family history of language delay, is another possibility. However, it's important to remember that not all children with speech delays fall into this category.

Therefore, a thorough evaluation is crucial for any child with speech or language delays to determine the underlying cause. And beyond medical evaluations, we need to emphasize the importance of providing a language-rich environment.

Sadly, many parents today are extremely busy and don’t have the time to engage in meaningful interactions with their children. It's not just about the quantity of time; it's the quality. Dedicated family time, where everyone engages in play and conversation, is essential. And of course, encouraging outdoor activities and limiting screen time is also beneficial for language development.

Madhavi Adimulam: You've touched upon a crucial point – the need for awareness and education, especially for professionals working with children with developmental delays. There's a significant increase in autism cases, and I feel there's a lack of specialized training for speech therapists in how to effectively support children with autism. We're seeing a gap in this area, and it's creating challenges.

Dr. Pranathi Gutta: I agree. Many therapists are young and haven't yet had the experience of raising their own families. But experience is invaluable in this field. And often, the focus seems to be more on delivering speech exercises rather than fostering true communication. With children on the autism spectrum, building genuine communication and engagement is essential. Parents need to be actively involved in this process as well.

Madhavi Adimulam: Absolutely. It's a collaborative effort. So, when do you recommend that parents seek speech therapy for their child? What are the signs that it’s time to intervene?

12. When to Consider Speech Therapy

Dr. Pranathi Gutta: We have established speech and language milestones that provide a general guideline. The WHO (World Health Organization) has published these guidelines, and they are readily available online. For example, if a child isn’t cooing or making sounds by 6-8 weeks, that's a concern. By nine months, they should be babbling. By 15 months, they should have a few meaningful words, and by 18 months, they should be using 20-30 words and starting to put two words together to form short phrases.

If a child is not meeting these milestones, it’s essential to seek professional guidance.

Madhavi Adimulam: So those milestones can be a helpful starting point for parents. Now, early intervention is a core principle at Ananya CDC, and we know it's crucial for many conditions, including autism.

13. Early Intervention in Autism

Madhavi Adimulam: Can you talk about the role of early intervention in autism, especially from a neurological perspective?

Dr. Pranathi Gutta: The earlier we identify and address developmental concerns, the better the long-term outcomes. Early intervention leverages the brain’s natural plasticity, its ability to change and adapt. When we start early, the potential for positive change is much greater, and the need for intensive therapeutic services later on is often reduced.

Even if a formal autism diagnosis isn't possible before 18 months, if we see signs of socialization and communication difficulties, repetitive behaviors, and restricted interests, we can start interventions. Early intervention can significantly reduce the need for special education, shadow teachers, and extensive therapy later on. It sets the child on a more positive developmental trajectory.

Madhavi Adimulam: So, the message is clear: pick up early, intervene early! Now, at Ananya CDC, we offer a range of therapies, including speech therapy, occupational therapy, and behavior therapy.

14. Recommending Therapies for Children with Autism

Madhavi Adimulam: Do you recommend all three therapies - speech, occupational, and behavior therapy - for children with autism? Do you typically suggest them in a particular order, or how do you approach this?

Dr. Pranathi Gutta: It really depends on the individual child's needs. We thoroughly assess each child and tailor our recommendations. If a child presents with sensory issues, then occupational therapy is recommended.

In most cases, I'd say behavior modification therapy is incredibly important. Occupational therapy isn't always necessary, but we evaluate every child for potential sensory issues that might necessitate it.

Madhavi Adimulam: And what about behavior therapy? Do you lean towards a specific approach, like ABA?

Dr. Pranathi Gutta: We don't have many well-trained, certified ABA therapists in Hyderabad. So, I believe any form of behavior modification, where we analyze the behavior and its root causes, is essential. We focus on training parents to identify the root cause of a behavior rather than just reacting to the behavior itself. That's what most psychologists are trained to do, and they can adapt their skills to the unique needs of children with autism.

There are some programs, like the Autism Intervention Training Program run by UMAID, that specifically train parents in these strategies. We have a few trained professionals in Hyderabad who can deliver this program.

I firmly believe any therapy is better than none. However, we can't just blindly apply a standardized ABA approach without considering the individual child.

Madhavi Adimulam: Exactly. At Ananya, we prefer a more holistic approach, focusing on Positive Behavior Supports (PBS) rather than traditional ABA.

Dr. Pranathi Gutta: That’s a great approach. Now, let’s address a common concern for parents who are noticing developmental challenges in their children.

15. Guidance for Parents

Madhavi Adimulam: Dr. Pranati, as an experienced pediatric neurologist in Hyderabad, what is the most important piece of guidance you would offer to parents who are concerned about their child and worried that they may have a neurological condition?

Dr. Pranathi Gutta: My advice is simple: start with your pediatrician. Pediatricians are trained to assess a child's development and can identify potential concerns. They can then guide parents towards the appropriate specialists, whether that's a developmental pediatrician, a neurologist, or a therapist. We all work collaboratively to address the child's needs.

Madhavi Adimulam: That makes a lot of sense. So, parents shouldn’t hesitate to reach out to their pediatrician as a first step.

Dr. Pranathi Gutta: Exactly. And once a child is referred to a specialist, we conduct a comprehensive assessment to identify their strengths and weaknesses. We then advise the parents based on the child's individual profile. Some children might need regular therapeutic intervention, while others might require a more tailored approach.

16. Conclusion and Final Thoughts

Dr. Pranathi Gutta: Madhavi, thank you for having me on the podcast today. It's been a pleasure to discuss these important topics related to child development and neurology in Hyderabad. I'm a strong believer in early intervention. The earlier we identify and address a child's needs, the better the outcomes will be. I appreciate your efforts in spreading awareness and making these resources more accessible to families in our community.

Madhavi Adimulam: Thank you so much, Dr. Pranathi. It's been an honor to have you on the podcast. And for our listeners in Hyderabad, if you're seeking support for your child's development, including speech therapy, occupational therapy, or help with autism or ADHD, please visit Ananya Child Development Center. We offer a range of therapies and assessments to help children reach their full potential. You can find us online at wordpress-1511319-5804593.cloudwaysapps.com or call us at (984) 851-3192.

Thank you for joining us on the Ananya CDC podcast! We'll be back soon with more experts and helpful discussions on child development. Until then, take care and keep nurturing those amazing little ones.