Curriculum standards
Curriculum standards
Completion requirements
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Advanced Training in Neurology (Paediatrics & Child Health)
Knowledge guides
LG19: Disorders of consciousness and sleep
Key presentations and conditions
Advanced Trainees will have a comprehensive depth of knowledge of these presentations and conditions.
Less common or more complex presentations and conditions
Advanced Trainees will understand these presentations and conditions.
Advanced Trainees will understand the resources that should be used to help manage patients with these presentations and conditions.
Epidemiology, pathophysiology, and clinical sciences
Advanced Trainees will have a comprehensive depth of knowledge of the principles of the foundational sciences.
Investigations, procedures, and clinical assessment tools
Advanced Trainees will know the scientific foundation of each investigation and procedure, including relevant anatomy and physiology. They will be able to interpret the reported results of each investigation or procedure.
Advanced Trainees will know how to explain the investigation or procedure to patients, families, and carers, and be able to explain procedural risk and obtain informed consent where applicable.
Important specific issues
Advanced Trainees will identify important specialty-specific issues and the impact of these on diagnosis and management and integrate these into care.
Presentations – disorders of consciousness
- Akinetic mutis
- Bulging fontanelle
- Coma
- Confusion
- Delirium
- Delusions
- Depersonalisation / Derealisation
- Disturbed vision, including diplopia or visual loss
- Dizziness
- Hallucinations
- Headache
- Illusions
- Lethargy
- Locked-in syndrome
- Minimally conscious state
- Obtundation / Stupor
- Seizures
- Syncope
- Vegetative state (VS) / Unresponsive wakefulness syndrome (UWS)
- Vomiting
Presentations – sleep
- Acute sleepiness
- Apnoea or loud snoring
- Concentration / Memory difficulties
- Confusion when waking
- Difficulty sleeping
- Enuresis (bed-wetting)
- Episodes of incomplete awakening and limited responsiveness
- Excessive daytime somnolence
- Hypersomnia
- Morning headaches
- Night terrors
- Periodic limb movements
- Sleep paralysis
- Sleepwalking
- Sudden attacks of sleep
Conditions – infectious, inflammatory, and toxic
- Acute disseminated encephalomyelitis (ADEM)
- Acute leucoencephalopathy with restricted diffusion / Acute encephalopathy with biphasic seizures and restricted diffusion
- Autoimmune
- Demyelinating
- Drug withdrawal
- Electrolyte disturbance
- Encephalitis
- Endocrinopathies
- Hepatic
- Hypernatremia
- Hypoglycaemia
- Hyponatremia
- Meningitis
- Metabolic
- Prescribed and illicit drugs
- Renal
- Shock
- Systemic conditions
- Toxic drugs:
- illicit
- prescribed
- Vasculitis
Conditions – psychiatric
- Anxiety
- Factitious illness
- Functional neurological disorder
- Paediatric acute-onset neuropsychiatric syndrome
- Panic attacks
Conditions – sleep
- Apnoea of prematurity
- Cataplexy
- Chiari malformation
- Down syndrome
- Hypersomnia
- Insomnia
- Narcolepsy
- Obstructive sleep apnoea:
- adenotonsillar hypertrophy
- airway abnormalities
- craniofacial abnormalities
- neuromuscular conditions
- obesity
- Parasomnia:
- confusional arousals
- non-rapid eye movement (REM) night terror
- periodic limb movement disorder
- REM sleep behaviour disorder
- sleep paralysis
- sleepwalking
- Prader–Willi syndrome
- Restless leg syndrome
- Sleep-disordered breathing
Conditions – structural
- Abscess
- Haemorrhage
- Hydrocephalus
- Raised intercranial pressure
- Space-occupying lesions
- Stroke
- Tumour
Conditions – other
- Arterial dissection
- Breath-holding
- Cardiac
- Cerebrovascular
- Continuous spikes and waves during sleep (CSWS)
- Endocrine:
- diabetic ketoacidosis
- thyroid issues
- Epilepsy
- Epileptic encephalopathy
- Hydrocephalus
- Hypoxia
- Hypoxic ischaemic encephalopathy
- Migraine and migraine equivalents
- Neurocardiogenic
- Non-convulsive status
- Pontine stroke
- Postictal state
- Seizures
- Smoke inhalation
- Syncope
- Trauma, including:
- concussion
- inflicted injury
- Traumatic brain injury
- Vertibrobasilar insufficiency
For each presentation and condition, Advanced Trainees will know how to:
Synthesise
- recognise the clinical presentation
- identify relevant epidemiology, prevalence, pathophysiology, and clinical science
- take a comprehensive clinical history
- conduct an appropriate examination
- establish a differential diagnosis
- plan and arrange appropriate investigations
- consider the impact of illness and disease on patients and their quality of life when developing a management plan
Manage
- provide evidence-based management
- prescribe therapies tailored to patients’ needs and conditions
- recognise potential complications of disease and its management, and initiate preventative strategies
- involve multidisciplinary teams
Consider other factors
- identify individual and social factors and the impact of these on diagnosis and management
Conditions
- Congenital central hypoventilation syndrome
- Iatrogenic illness
- Kleine–Levin syndrome
For each presentation and condition, Advanced Trainees will know how to:
Synthesise
- recognise the clinical presentation
- identify relevant epidemiology, prevalence, pathophysiology, and clinical science
- take a comprehensive clinical history
- conduct an appropriate examination
- establish a differential diagnosis
- plan and arrange appropriate investigations
- consider the impact of illness and disease on patients and their quality of life when developing a management plan
Manage
- provide evidence-based management
- prescribe therapies tailored to patients’ needs and conditions
- recognise potential complications of disease and its management, and initiate preventative strategies
- involve multidisciplinary teams
Consider other factors
- identify individual and social factors and the impact of these on diagnosis and management
- Acute, chronic, common, and rare diseases that result in decreased consciousness and disorders of sleep
- Conditions required for brain death diagnosis
- Neuroanatomy, neuropharmacology, and neurophysiology of:
- brain and brainstem mechanisms involved in the maintenance of normal consciousness
- normal sleep function
- Pathological mechanisms that result in:
- decreased consciousness
- disturbed sleep, and describe the way disorders of sleep can present
Assessments
- Epworth Sleepiness Scale for Children and Adolescents
- Glasgow Coma Scale
- Neurobehavioural assessment tools in children with disorders of consciousness, such as:
- Cognitive and Linguistic Scale (CALS)
- Coma Recovery Scale for Pediatrics (CRS-P)
- Pittsburgh Sleep Quality Index (PSQI)
- Sleep Disturbance Scale for Children (SDSC)
Cerebrospinal fluid (CSF) procedures and investigations
- Lumbar puncture (LP) and interpretation of investigation results, such as:
- basic CSF analysis:
- cell count
- cytology
- glucose level
- immunological tests
- microbiological tests
- neurotransmitters
- protein level
- xanthochromia
- opening pressure
- special tests:
- oligoclonal bands
- basic CSF analysis:
Clinical neurophysiology investigations
- EEG:
- sleep-deprived EEG
- standard EEG
- video EEG
- Evoked potentials:
- brainstem
- somatosensory
- visual
Neurogenetic investigations
- Genetic testing, including, but not limited to:
- chromosomal testing, such as:
- karyotype
- microarray
- genomic testing, including whole exome or genome sequencing
- mitochondrial genome sequencing
- targeted panel testing
- chromosomal testing, such as:
- Referral to a neurogeneticist
Neuroimaging investigations
- CT, including:
- CT angiography
- perfusion
- Functional imaging:
- functional MRI (fMRI)
- PET
- single photon emission computed tomography (SPECT)
- Magnetic resonance:
- angiography (MRA)
- spectroscopy (MRS)
- venogram (MRV)
- MRI
- Vascular imaging:
- catheter angiography
- Doppler ultrasound
Neuroimmunology investigations
- Autoantibody measurement:
- anti-acetylcholine receptor antibodies
- anti-aquaporin 4 antibodies
- limbic encephalitis autoantibody testing
- myelin oligodendrocyte glycoprotein (MOG) antibody
- other autoimmune conditions with neuropsychiatric manifestations, such as:
- systemic lupus erythematosus (SLE)
- Referral to a neuroimmunologist
Neuropathology investigations
- Brain biopsy
Neuropsychological investigations
- Cognitive screening:
- Mini-Mental State Examination
- Referral to a neuropsychologist
Other investigations
- Cardiac investigations:
- 24-hour electrocardiogram monitoring
- ECG
- echocardiography
- Other laboratory tests:
- ammonia
- blood gas
- blood glucose
- coagulation profile
- cortisol
- infection screen
- lactate
- plasma amino acids
- pyruvate metabolic
- serum electrolytes
- sugar
- thiamine
- urine drug screen
- urine metabolic profile
- Polysomnography
- Conditions that mimic disturbance of consciousness, such as:
- acute dysphasic
- functional disorders, including:
- non-epileptic status epilepticus
- locked-in syndrome
- stroke
- Conditions that result in prolonged disturbance of consciousness, such as:
- minimally conscious state
- persistent vegetative state
- Diagnosis and management approaches for patients with altered states of consciousness
- Differentiation of sleep disorders from related neurological presentations, such as frontal lobe epilepsy and parasomnias, and night terrors
- Prioritise aspects of management for patients with altered states of consciousness
- Prognosis and implications of sleep disorders, such as driving
- Working with multidisciplinary teams, particularly intensive care