Neurological Examination worthwhile?
 

My seven-year-old son was recently given a short neurological examination due to migraine headaches that were awakening him in the night. During that examination he was found to have a positive babinksi's sign on his right foot only. Another notable finding were "faster" knee reflexes. He has been treated conservatively for the migraines with Amitriptyline, close attention to diet, hydration, and sleep, and all of which have helped. During his follow-up examination, the positive babinksi was still present. However the pediatrician does not seem all that concerned about it and did not recommend any further evaluation unless his symptoms increase or anything changes. However, other notable facts about my son- he has sensory processing disorder(mild), dyslexia, asthma(mild), tight hamstrings-like REALLY tight, hammer toes, was speech delayed and had apraxia (imagine my frustration, I am a speech therapist!), and has some behavioral concerns that make me think about Asperger's, (but that could be an occupational hazard). So, I am wondering if I should pursue a more thorough neurological examination to determine causality of this positive babinksi's sign? Afterall, it can be a sign of brain or spinal cord damage in the ER, right? When I asked his pediatrician about what might be the cause, she did mention it could be "mild CP", but she really did not pay much mind to it. Recommendations or thoughts would be greatly appreciated.

Hi there,
Welcome to the NeuroTalk Support Groups.

I just saw your post here and I'm sorry that the Children's Health forum isn't very busy at the moment.

I don't really know what to suggest, except to say that as far as I know a positive Babinski sign in a 7 year old would be concerning. Why that is only in one foot, I don't know.

I'd certainly be asking for further investigation if he was my son and knowing that it "can" be a sign of quite serious conditions.

If you have a good rapport with his Paediatrician, then I'd talk with her again about your concerns. Considering all that your son has going on for him, then it might be helpful to know more.

I'm not sure what you mean about your son's migraines waking him in the night. How often is he having migraines?

My son had migraines from around 5 years of age to around 11 or 12 (totally grown out of them now as an adult). He also had night terrors as a young child. He had a complicated medical history related to a GABHS infection (Sydenham's Chorea) and was later differentially diagnosed with other conditions including Aspergers and a tic disorder/TS.

Go with your gut feeling. If you feel you need to know more then you need to go back and ask.

p.s. I thought I'd leave the link to the NeuroTalk
Cerebral Palsy Forum
here as well, just in case you wanted to post over there.
It's also a quiet forum but you never know, someone might see your post and have some suggestions.

Thank you for your reply Lara...
 

Thank you so much for your reply Lara. I have been feeling like I should trust my gut and have this further investigated. But I don't want to come across as a hypochondriac. Certainly there are many other children who are more complicated and are in more "need" of this kind of care. As far as migraines waking him- he would go to sleep without a headache, and wake up about 2 hours later with a migraine. Concerning, I know. However the pediatrician seems placated with the fact that his headaches have not persisted since we began Amitriptyline. Had this medication not helped, the next step would be an MRI with contrast. I think I am going to pursue a second opinion with a pediatrician I know to be a little bit more aggressive. I thank you again for your reply!

I felt the same way, but in the end I asked for another opinion. We ended up seeing a couple of different Paediatricians and then in the end got a referral to see a Paed. Neurologist. My son did end up having an MRI and LP. It was terribly invasive and just horrible for him, but they did rule out some other really serious problems that they were concerned about due to symptoms.

It's great that the medication is helping with the migraines! I now understand why your son's doctor hasn't been more aggressive about that.

I'd still see a Neurologist, but that's just me. They have the experience with the neuro exams and perhaps can pinpoint exactly what is going on and why there is the one sided Babinski and yet strong knee reflexes.

After I wrote the first message, I went away and thought of something I'd meant to ask you... how is his gait? No toe walking or anything unusual with his gait? You did mention the hamstrings but I just wondered.

All the best to you and your son.
I hope you come back and let me know how you get on.

Hi again Lara, I contacted my friend/more aggressive pediatrician and he was pretty clear that a referral to a neurologist would definitely be the next best step. He stated that the "wait and see" line is BS in these cases. (I love his candidness! :) In response to your question about his gait- it's normal. But his pediatrician did ask about that as well. He has been seen by a PT in the past for the tight hamstrings, and I feel pretty certain there were no concerns about gait back then (he was 4) either. I also saw I did not answer your question about frequency of migraines- they were about 6 per year. But he hasn't had one since he began the medication about 2 months ago! :)In any case, I have registered him with a reputable neurology clinic in my area and will hopefully have an evaluation scheduled in the next few weeks. I will keep you posted- nice to have someone to chat with about these things who has similar concerns. Is your son doing well? Sounds like you had a pretty scary time of it when your son was young!
Just noticed that you are in Australia! Even more amazing to be chatting with someone across the world! The internet can be pretty awesome.

That's really good news. I'm pleased you have an appointment with the Neurologist.
Yes, my son is an adult now and living an independent life.
At one time there it didn't look as if that would be possible.
The toddler to teen years especially were very difficult for many reasons.

Keep us updated.
Nice to talk with you as well. The internet certainly has been a lifesaver for many.

SLP MOM,

Hi, the only thing that stands out to me are the very tight hamstrings. My daughter had the same thing for years. During an X-ray they found she had broken the pars off her L5-S1 vertebrae. It's not a painful break and the bones wore away leaving her spine unattached by bone at the L5-S1

Not that your sone has that but an X-ray could not hurt if you have the chance.

At 10 my daughter had a disc replaced and a cage put in.

I hope you get answers soon for your little one. My thoughts are with you and yours.

Jace