Curriculum standards

• Anatomy and physiology of the nervous system, including neuroembryology
• Electrophysiologic concepts as they relate to neuronal interactions
• General approach to, and differences in, assessing neonates / infants / children / adolescents
• Mechanisms by which underlying neuroanatomical, neuropathological, and neurophysiological processes result in neurological symptoms and abnormal neurological signs
• Microanatomy and histology of brain, meninges, and peripheral nerves
• Neuroanatomy and neurophysiology of the central nervous system (brain and spinal cord) and its vascular supply
• Neuroanatomy and neurophysiology of muscle, the neuromuscular junction, and the peripheral nervous system, and its vascular supply
• Normal child and adolescent development
• Normal neurodevelopmental changes from premature neonate to adulthood

Neuroimmunology

• Immunology and the processes involved in the generation of immunologically mediated neurological conditions
• Role of the immunologist

Neurogenetics

• Epigenetics
• Genetics and the patterns of inheritance of inherited neurological conditions, including classifications of genetic syndromes
• Knowledge of practical genomics

Neuropsychiatry

• Functional neurological disorders, both acute and chronic, including those presenting as movement disorders, non-epileptic seizures, and weakness
• Neurological basis of psychiatric presentations
• Pharmacological and behavioural treatment of neuropsychiatric illnesses, and potential drug interactions
• Psychological sequelae of chronic neurological illnesses and their management
  • anxiety
  • conversion
  • depression
  • psychosis
• Role of the child psychologist and child psychiatrist

Neurorehabilitation

• Formulation of a prognosis based on the natural history of the relevant condition coupled with clinical assessment of the relevant markers for recovery
• Neurorehabilitation, including:
  • goal setting
  • indications for referral
  • setting realistic outcome expectations
  • the techniques employed
• Place of dorsal rhizotomy
• Recovery from neurological illness and/or injury, including the natural history and neuronal plasticity
• Role of botulinum toxin in the management of spasticity
• Role of the rehabilitationist, including:
  • continence advisors
  • occupational therapists
  • orthopaedic and/or general surgeons in children
  • physiotherapists
  • social workers
  • speech pathologists
• Use of medical devices, such as baclofen pumps and deep brain stimulation

Therapeutic interventions

• Awareness of evolving therapies, particularly immunotherapy and gene therapy
• Classes of medication and dietary interventions used to treat acute and chronic neurological illness, including, but not limited to, those used in epilepsy, migraine management, movement disorders, neurogenetics, neuroimmunology, neuropathic pain, and neuromuscular and neurovascular disease:
  • common and uncommon adverse effects
  • indications
  • monitoring requirements
  • patient resources
  • potential drug interactions
  • safe and rational use
• Devices used in the specialist management of neurological diseases, such as baclofen pumps, deep brain stimulators, and vagal nerve stimulators:
  • common and uncommon adverse effects
  • indications
  • monitoring requirements
  • neuroanatomy and neuropathology related to implantation
  • principles of safe and rational use
• Evidence-based pharmacological therapy and other forms of management for various diseases and disorders
• Immunotherapy and cytotoxic drugs
• Management strategies for drug-resistant conditions, such as drug-resistant epilepsy, or those without accepted treatment protocols
• Nerve blocks and their role in pain management
• Neuropharmacology of drug interactions, metabolism, pharmacodynamics, and pharmacokinetics, along with the potential role of pharmacogenomics
• Place of complementary therapeutics
• Reperfusion therapy

Cerebrospinal fluid (CSF)

• Interpret CSF results, including normal ranges, such as:
  • opening pressure
  • special tests, such as:
    • amino acids
    • CSF cytology
    • glucose ratio
    • neurotransmitters
    • oligoclonal bands
    • polymerase chain reaction (PCR) for viruses
  • standard tests, such as:
    • cell counts
    • glucose
    • lactate
    • protein
• Limitations of interpretation, and the implications for formulating a diagnosis
• Lumbar puncture (LP):
  • anatomical landmarks and procedure
  • consent and counselling
  • contraindications
  • post-LP care
  • potential complications and their management, including post-LP headache and blood patch use
  • requests
  • urgent investigation
• Neuroanatomy and neurophysiology of CSF and its production, including the pathological mechanisms that underlie abnormalities of pressure and CSF constituents
• Pre-procedure checklist for contraindications, including fundoscopy

Clinical neurophysiology

• Abnormalities seen on clinical neurophysiology investigations
• Appearance of normal waveforms on neurophysiology testing, including the importance of variations with age, specifically evolution from preterm, neonate, and childhood to adulthood
• Interpretation of EEG, such as:
  • correctly localising focal epileptiform discharges and slow wave activity
  • normal and abnormal EEG waveforms
  • observing EEG electrode placement and recording
  • physiological basis of EEG potentials and waveforms
  • reporting EEG studies, and interpreting findings in clinical context
  • role and limitations of EEG
  • technology used for EEG recording
  • typical EEG patterns for age-dependent childhood epilepsy syndromes, such as:
    • centrotemporal and perisylvian tangential dipoles
    • generalised 3Hz spike wave
    • hypsarrhythmia
• Interpretation of electromyography (EMG) and nerve conduction studies (NCS) results, such as:
  • interpreting EMG and NCS reports
  • physiological basis of EMG and NCS:
    • potentials and waveforms
    • testing and results
  • technology used for EMG and NCS recording
• Interpretation of evoked potential results within the clinical context
• Recognising when to:
  • discuss the results with a neurophysiologist
  • question a formal report
  • request further test(s)
• The use of high-density EEG and stereoelectroencephalography (SEEG), its risks, and application of results to the clinical scenario

Neurogenetics

• Abnormalities seen on neurogenetic testing in appropriate conditions
• Acknowledgement of potential phenotypic variations within and between syndromes, such as 22q11.2
• Awareness of emerging testing
• Awareness of the range of genetic testing available
• Ethical considerations related to the consent of children
• Importance of pre-test counselling and the potential implications of a positive diagnosis for the patient and their family
• Limitations of investigations, such as mol karyotype versus gene panel versus whole exome sequencing (WES) versus whole genome sequencing (WGS), with / without other specialised testing
• Role of the clinical geneticist, and when to arrange a formal referral as opposed to performing a genetic test
• Techniques used in neurogenetics laboratories, including limitations in interpretation of the results, and implications on diagnosis formulation
• Utility of genetic testing in neurological diagnosis, even in asymptomatic individuals

Neuroimaging

• Abnormalities seen on neuroimaging investigations
• Appearance of a normal brain and spinal cord on neuroimaging techniques, including vascular anatomy and pathology
• Considerations of performing neuroimaging, including radiation risks and technical difficulties
• Neuroimaging investigations, such as CT, functional MRI, MRI, nuclear medical scans, and perfusion scans:
  • limitations to interpretation
  • place for other MRI techniques:
    • magnetic resonance:
      • angiography (MRA)
      • spectroscopy (MRS)
      • venogram (MRV)
    • tractography
  • risks and complications
  • sequences used
  • urgent investigations
  • uses and indications
• Pathological mechanisms that underlie imaging abnormalities
• Recognising when to:
  • discuss the results with a neuroradiologist
  • question a formal report
  • request further testing

Neuroimmunology

• Abnormalities seen on neuroimmunological testing in appropriate conditions
• Appearances on EEG and MRI of neuroimmunological lesions
• CSF immunological markers
• Limitations of interpretation, and implications for formulating a diagnosis
• Serological immunological markers
• Techniques used in the neuroimmunology laboratory, including limitations to the interpretation of the results

Neurometabolic disorders

• Awareness of those metabolic disorders that may be amenable to bone marrow transplantation or enzyme replacement therapy
• Clinical presentations and potential treatments of treatable neurometabolic disorders, such as Wilson disease and pyridoxine-dependent seizures
• Clinical presentations, investigations, and treatment of common neurodegenerative conditions in childhood, including metabolic, mitochondrial, and neurotransmitter disorders
• CSF lactate and amino acids
• Genetic implications of common neurometabolic conditions, including carrier state phenotype
• Neurologic presentations of common metabolic disorders in childhood and the differential diagnoses for these presentations, such as:
  • developmental regression
  • encephalopathy
  • intellectual deterioration
  • muscle weakness
  • paroxysmal dyskinesia
  • seizures
  • stereotypies
• Plasma and urinary amino acids
• Plasma ammonia, lactate, and pyruvate
• Results of common metabolic investigations, such as plasma amino acids and urine organic acids, and when to review in conjunction with metabolic physicians
• Structured approach to metabolic investigations in childhood, including identifying features such as age at presentation, clinical features, ethnicity, examination findings, and imaging or EEG features, such as distinguishing white matter versus grey matter disorders
• Urine gylcosaminoglycans
• Urine organic acids
• Urine purine and pyrimidine

Neuropathology

• Neuroanatomy of brain, muscle, and nerve, coupled with an understanding of the pathological mechanisms that underlie abnormalities seen on neuropathology
• Neuropathology investigations:
  • abnormalities
  • limitations of interpretation, and the implications for formulating a diagnosis
• Potential complications of neuropathology investigations, and the management of these complications
• Recognition that neuropathology laboratories may have specific requirements for the immediate processing of biopsied tissue, and advise surgeons performing these tests of relevant requirements
• Requesting assistance in performing these investigations from neurosurgeons, ophthalmologists, and/or vascular surgeons

Neuropsychology

• Abnormalities seen on neuropsychological testing
• Limitations of interpretation, and the implications for formulating a diagnosis
• Neuroanatomy and cognitive functions of the brain, and broadly how the various neuropsychological domains are tested by the neuropsychologist
• Roles of the neurologist and neuropsychologist in determining patients’ capacity to make decisions

Neurosurgery, including interventional radiology and vascular surgery

• Neuroanatomy, neuropathology, and neurophysiology of acute, chronic, common, and rare diseases
• Procedures:
  • brain tumour surgery, such as:
    • biopsy
    • debulking
    • excision
  • craniectomy and other procedures for the treatment of cranial malformations
  • CSF shunting, CSF diversion procedures, and neuroendoscopy
  • emergency surgical procedures for the management of trauma and acute raised elevated intracranial pressure (ICP), such as evacuation of intracranial haematoma
  • functional neurosurgery, such as procedures for:
    • deep brain stimulation
    • epilepsy
    • movement disorders
  • spinal surgery, such as:
    • laminectomy
    • microdiscectomy
  • vascular surgery, such as:
    • aneurysm clipping and coiling
    • endovascular clot retrieval
    • surgical procedures for treatment of moyamoya disease
• Role of the neurosurgeon, radiologist, and vascular surgeon

• Awareness of the full neurological examination in neonates and children, and the ways in which to enhance this in examining children of different ages and developmental stages
• Awareness of the International League Against Epilepsy (ILAE) guidelines for the classification and management of childhood epilepsy
• Impact of chronic illness on patients, families, and/or carers:
  • impact and interrelationship of comorbidities and neurological conditions on each other, including:
    • clinical presentation
    • diagnostics
    • impact of illness
    • management
    • prognostics
  • place of complementary treatments
• Patient care considerations for specific patient groups and those with culturally diverse backgrounds, including:
  • Aboriginal and Torres Strait Islander peoples
  • adolescents
  • ethnic minorities
  • low socioeconomic background
  • Māori
  • non-English speaking background
  • overseas travellers
  • pregnant and peripartum states
  • refugees
  • religious ideologies, such as Jehovah’s Witness

Neurological emergencies

• Acute, chronic, common, and rare diseases that present as neurological emergencies
• Neuroanatomy, neuropathology, and neurophysiology relevant to the various conditions presenting as neurological emergencies
• Rapid clinical assessment of patients with neurological emergencies:
  • evidence-based pharmacological therapy and other treatments used in acute neurological presentations, and their potential complications
  • prognosis and implications of these disorders
• Role of the intensive care unit, neurosurgeon, and palliative care physician

End-of-life (EOL) considerations

• EOL issues and consultation with patients and/or caregivers to determine management plans that prevent suffering
• Manage symptoms, such as:
  • anxiety
  • dyspnoea
  • hydration
  • nutrition
  • pain
• Techniques used by palliative care physicians, along with the potential complications of any procedures involved