Why is my child falling down so much? An approach on how to manage children who present with poor coordination: A literature review and a study of three cases

Abstract

While ataxia is a relatively common presenting symptom in pediatric patients, it represents only one possible cause of uncoordinated movements. Other possible causes of uncoordinated movements include ingestion of toxic substances, musculoskeletal diseases, psychogenic disorders, and epilepsy. Therefore, primary health care providers must recognize and eliminate other aetiologies of uncoordinated movements before attaching the label ‘ataxia’ to any patient presenting with poor coordination. Once the presence of ataxia is confirmed, the cause should be investigated. Furthermore, as ataxia may be vestibular, sensory, or cerebellar in origin, practitioners must evaluate the diverse symptoms and signs to effectively differentiate the various subtypes of ataxia. Three case studies will be presented to illustrate the complexity associated with the assessment of ataxia. Each case will introduce a pediatric patient who displays cerebellar ataxia as a concurrent feature of a gene-specific epileptic encephalopathy. These cases will provide an example of how ataxia may be differentiated from other causes of uncoordinated movements related to epilepsy and anti-seizure treatment, namely: nonconvulsive seizures, postictal state, and medication side effects or toxicity. The assessment of poor balance can be challenging at times; however, with an appropriate clinical assessment, the evaluation of incoordination does not need to be intimidating for general practitioners. With knowledge of the differential diagnosis of poor balance, medical practitioners will be able to confidently determine the presence of true ataxia from various ataxia mimickers, thereby allowing for timely and accurate diagnosis and appropriate management.