Pediatric Neurology, Part III

儿童既不是成人的袖珍版也非不成熟的人类：在每个阶段，它展现特定的能力以优化其对环境的适应并发展新学习的能力。儿童疾病覆盖了成人阶段遇到的所有专科，这其中神经病学尤其涉及庞大的领域，从大脑到横纹肌，发生和发挥功能需要整个基因组的半数和大部分线粒体基因。人体神经系统对出生以前的伤害敏感，在出生时特别不成熟，其发育在全程可能受年龄相关疾病影响，这一点和成人不同。即便是成人阶段更常见的疾病在发育中的神经系统也会有特异性的体现。始于青春期之前的慢性神经系统疾病与成人的病理学截然不同——不管是从认知还是运动方面来看，直到成人，成人神经病学家关注这些儿童时期伴有持续性神经系统疾病的患者在成为成人以后的状况，这个领域正在发展当中。正因小儿神经病学发展为一个专门的学科，其数据容量和的复杂性对于全科儿科医生或成人神经病学家来说委实太多，难以掌握，这个学科目前接着向前发展为许多亚学科，例如癫痫、神经肌肉疾病、卒中、畸形、新生儿神经病学、代谢性疾病等等，故而全科儿科神经病学家无法适度地在所有领域拥有深度专业知识，特别是对复杂案例的处理。我们为一些进修医生提供在全科儿科神经病住院医生之后的奖学金项目，以帮助他们掌握亚学科专业知识。许多此类奖学金项目包括了研究的培训。由于遗传背景和医学实践在全球不尽相同，这种多样性需要在儿科神经病学教科书得以体现。综上所述，以及虽然大脑畸形（H. Sarnat & P. Curatolo 2007）和肿瘤学（W.Grisold & R. Soffietti）在本系列丛书其他卷中得到了详细阐述故而在本书中仅作简单介绍，对这些因素的考虑说明了本系列卷数众多、来自全球的众多作者参与其中的必要性。不同亚学科的专家们还对总体框架和术中内容设定贡献良多。本书特别关注发育方面，如果需要，总体会提示正常发育的情况——大脑、肌肉和免疫系统。本书还介绍了进展至成年期的慢性疾病的病程和发育中的神经系统相关的伦理问题。

The child is neither an adult miniature nor an immature human being: at each age, it expresses specific abilities that optimize adaptation to its environment and development of new acquisitions. Diseases in children cover all specialties encountered in adulthood, and neurology involves a particularly large area, ranging from the brain to the striated muscle, the generation and functioning of which require half the genes of the whole genome and a majority of mitochondrial ones. Human being nervous system is sensitive to prenatal aggression, is particularly immature at birth and development may be affected by a whole range of age-dependent disorders distinct from those that occur in adults. Even diseases more often encountered in adulthood than childhood may have specific expression in the developing nervous system. The course of chronic neurological diseases beginning before adolescence remains distinct from that of adult pathology – not only from the cognitive but also motor perspective, right into adulthood, and a whole area is developing for adult neurologists to care for these children with persisting neurological diseases when they become adults.
Just as pediatric neurology evolved as an identified specialty as the volume and complexity of data became too much for the general pediatician or the adult neurologist to master, the discipline has now continued to evolve into so many subspecialties, such as epilepsy, neuromuscular disease, stroke, malformations, neonatal neurology, metabolic diseases, etc., that the general pediatric neurologist no longer can reasonably possess in-depth expertise in all areas, particularly in dealing with complex cases. Subspecialty expertise thus is provided to some trainees through fellowship programmes following a general pediatric neurology residency and many of these fellowships include training in research.
Since the infectious context, the genetic background and medical practice vary throughout the world, this diversity needs to be represented in a pediatric neurology textbook. Taken together, and although brain malformations (H. Sarnat & P. Curatolo, 2007) and oncology (W. Grisold & R. Soffietti) are covered in detail in other volumes of the same series and therefore only briefly addressed here, these considerations justify the number of volumes, and the number of authors who contributed from all over the world. Experts in the different subspecialties also contributed to design the general framework and contents of the book. Special emphasis is given to the developmental aspect, and normal development is reminded whenever needed – brain, muscle and the immune system. The course of chronic diseases into adulthood and ethical issues specific to the developing nervous system are also addressed.