Student Development Guidelines

1. Dr. Ajay Goenka MD
PRESENT
AFFILIATION:
American Board certified in Neurology, Child Neurology and
Epilepsy
Senior consultant at EHCC and Neo clinic Hospital
MAJOR
ACHIEVEMENTS:
(HONOURS)
(AWARDS)
(PUBLICATIONS)
MBBS: 2000 Batch SPMC Bikaner
MD Peds: 2007/2011- CMC Vellore and Mount Sinai University
New York
Neurology/Peds Neurology: 2013-2016 Montefiore Medical
Centre, NY
Fellowship in Clinical Neurophysiology 2016-2017
Assistant Professor Wright State University, Ohio, USA 2017-
32 Publications in International Journals with citation Score: 124

2. Poor School
Performance
• Education is one of the most important aspects
of human resource development.
• Poor school performance results in the child
having a low self-esteem, and significant stress
to the parents.
• Poor academics can be due to multiple factors
and needs an integrated team approach
• Poor school performance Karande S, Kulkarni M.Indian J Pediatr. 2005 Nov;72(11):961-7

3. Medical Reasons for poor academic performance
• Seizures (Absence Seizures)
• Hypersomnia (Narcolepsy)
• Obstructive Sleep Apnea
• Learning Disabilities
• Procrastination and time management
issues
• ADHD (Attention deficit hyperactive
disorder)
• ADD (Attention deficit disorder)
• Nutritional Deficiencies

7. Absence Seizure

9. Jeavons

11. Myoclonic Seizure

17. Sleep problems
and poor academic
performance
• Prevalence of sleep problems and their associations with poor
academic performance was performed in 27 primary schools
in Hannover, Germany
• Sleep problems (e.g., sleep onset delays, night awakenings,
sleepwalking, nightmares, and bedwetting) were examined by
parental and children’s questionnaires.
• Of 1,144 children enrolled (mean age 9.6 years, 51% males),
760 (66.4%) had sleep problems reported by their parents,
with sleep onset delays having the highest prevalence.
• Significant associations with academic performance were
found for night awakenings and nightmares
Sleep problems and poor academic performance in primary school children S. Wiechers

19. OSA and poor academic performance
This study was done to estimate the prevalence of OSA in school children
aged 5-10 years and its association with academic performance.
22-item pediatrics sleep-related breathing disorder (SRBD) scale was
distributed to 1820 pupils in three primary schools.
The prevalence of OSA among children in our study was 9.6% (95% CI:
8.1%-11.7%).
Students with positive SRBD were more prone to nocturnal enuresis (NE)
(OR 3.48; 95% CI 2.27-5.26) and poor academic performance in all subjects.
Association of pediatric obstructive sleep apnea with poor academic performance: A school-based study from India Goyal A, Pakhare AP, Bhatt GC,
Choudhary B, Patil R.Lung India. 2018 Mar-Apr;35(2):132-136. doi: 10.4103/lungindia.lungindia_218_17

20. Twenty Year Follow up Study OSA
We performed a 20-year follow-up of patients with polysomnography-
documented OSA in childhood to evaluate the long-term
anthropometric, sleep, cognitive, and cardiovascular outcomes.
Young adults with confirmed severe OSA in childhood had significantly
higher adulthood body mass index (P = .038), fewer academic degrees
(P < .001), and more snoring (P = .045) compared to control patients.
Adults with a history of severe childhood OSA have a high risk of
snoring, elevated body mass index, and lower academic achievement in
adulthood.
Twenty-year follow-up of children with obstructive sleep apnea Nosetti L, Zaffanello M, Katz ES, Vitali M, Agosti M, Ferrante G, Cilluffo G, Piacentini G,
La Grutta S.J Clin Sleep Med. 2022 Jun 1;18(6):1573-1581.

21. Neuro-
Psychological
Assessment
1.Wechsler Adult Intelligence Scale– Fourth Edition (WAIS-IV)
• Similarities, Vocabulary Information, Digit Span, Arithmetic, Block
Design, Matrix Reasoning, Visual Puzzles, Symbol Search, Coding
• Verbal Comprehension Index
• Perceptual Reasoning Index
• Processing Speed Index
• Working Memory Index
• Full Scale IQ
2. Wide Range Assessment of Memory and Learning- Second Edition
• Verbal Learning, Verbal Learning- Recall, Verbal Learning Recognition
3. Test of Visual Perceptual Skills – 4th Edition
• Visual Discrimination and Visual Memory
4. Rey Complex Figure Test
• Copy, Time to Copy, Immediate Recall, Delayed Recall, Recognition

22. Nutrition and school performance
Meta analysis of published studies on the association between nutrition among
school-aged children and their cognitive functioning.
Food insufficiency, iron deficiency and supplementation, deficiency and
supplementation of micronutrients, and the importance of breakfast.
Results show iron deficiencies sufficient to cause anemia are at a disadvantage
academically. Their cognitive performance seems to improve with iron therapy.
A similar association and improvement with therapy is not found with either zinc
or iodine deficiency.
There is no evidence that population-wide vitamin and mineral supplementation
will lead to improved academic performance
Nutrition and student performance at school.Taras H.J Sch Health. 2005 Aug;75(6):199-213.

24. Work up and
Treatment
A detailed history including the school performance, family
history, medications, sleep.
A detailed questionnaire filled from the teachers and the
parents regarding the behavior, sleep and academics.
A detailed physical exam to assess signs of poor nutrition,
neurocutaneous markers, developmental assessment.
Neuropsychological Assessment to assess for learning
difficulties
Based on the assessment planning for the investigations

25. Work up and
Treatment
MRI Brain (Assess for old lesions/strokes, Focal
cortical dysplasia, leukodystrophy)
Blood work to rule any underlying nutritional,
metabolic or endocrine problems
Overnight EEG in our EEG labs ( Landau Klefner
syndrome, Subclinical seizures, subtle seizures)
Overnight Sleep study in sleep lab (OSA,
Narcolepsy, Sleeping disorders)
Finally, assessment and detailed plan by the
Pediatric Neurologist.

26. Take home message
1. Change in behavior, academic performance or sleep
patterns should be investigated
2. For episodic changes, continuous EEG monitoring are
helpful
3. Always do a proper workup before reaching a conclusion.

27. • CAPD- USH2A ( Usher Syndrome, AR)
• ADHD- ADGRL3, high heritability of 74%, dopamine D4 receptor gene VNTR
and a dopamine D5 receptor gene microsatellite marker. COMT val158/108 met
variant
• Absence Seizure: GABRG2
• Focal Seizure: DEPDC5, NPRL2
• Jeavon Syndrome: PLCB1 gene
• Narcolepsy: HLA-DQB1*06:02