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Maurizio De Negri Paola Giovanardi Rossi Franco Guzzetta Giovanni Lanzi Pietro Pfanner

Toward a departmental view of developmental neurosciences

Received: 16 December 1995

Sir: In the September 1995 issue of Child's Nervous System, our col- leagues Profs. Pavone, Cavazzuti, and Fois (paediatricians) have signed an editorial entitled "Neuropaediat- rics" [1]. This editorial is very com- prehensive: it includes general ob- servations and references to the Ital- ian condition, mainly to the problem of the relationship between general neurology, general paediatrics, child neurology and child neuropsychiatry.

We would like to add the follow- ing remarks:

1. General observations. As under- lined in the editorial, developmental neurology is becoming more and more important both in the scien- tific-cultural and clinical fields. Some 25 -30% of pediatric hospital- izations are for neurologic or neuro- psychiatric conditions. It is also well known that the clinical aspect of de- velopmental neurology as related to the problems of children with major or minor brain dysfunction, should include not only the biological as- pects, but also the cognitive, rehabil- itation, and emotional aspects.

The problem of whether the child neurologist or the child neuropsychi- atrist had their previous experience in the field of general neurology or of general paediatrics is now out- dated and belongs to the history rather than to the future of the disci- pline, since in either case it is neces- sary to acquire a new culture and clinical experience, i.e., that of de- velopmental neurology. This disci-

pline is so specific from a cultural point of view, so wide in its field of application, and so multidisciplinary (involving maturational neurology, clinical electrophysiology, biochem- istry, genetics, neuroradiology, neu- rosurgery, neuropsychology, rehabil- itation, and psychiatry) that the old nominalism should make way for a new view of an independent "De- partment of Developmental Neuro- logic and Neurobehaviourat Sci- ences." Several institutes have al- ready adopted and even started this process of organization.

2. References to the Italian condi- tion. The present Italian condition is characterized by delays and contra- dictions, but this historical process is in progress. There have been re- cently the following legislative measures: (a) According to the new regulations governing the University course in Medicine and Surgery (re- vised Table XVIII 1995), the paedi- atric disciplines should be subdi- vided into three basic groups: gen- eral paediatrics, child surgery, and child neuropsychiatry, thus recogniz- ing the specificity of this latter. (b) The new regulations of the Special- ization School in Child Neuropsychi- atry (Supplement to the Gazzetta Uf- ficiate no. 167, 1995) provide for a 5-year training, with teaching pro- grammes very similar to those pro- posed in the editorial by Profs. Pa- vone, Cavazzuti, and Fois for the hy- pothesized specialization in Child Neurology. The only difference is that in the latter the psychotherapeu- tic approach is not provided for, whereas it is included in the pro- gramme of the specialization in Child Neuropsychiatry. However, this aspect should be considered of importance, due to the clinical, reha- bilitation, and adaptive needs of the child with brain dysfunction, as also recognized in the above editorial (apart from a psychoanalytic train- ing, which is not included in any programme and remains absolutly free and optional).

Reference

1. Pavone L, Cavazzuti GB, Fois A (1995) Neuropaediatrics. Child's Nerv Syst 11:501-503

M. De Negri ([]) Department of Neuropsychiatry, University of Genoa, Istituto G. Gaslini, Largo G. Gaslini 5, 1-16148 Genoa, Italy

R Giovanardi Rossi Department of Neuropsychiatry, University of Bologna, Istituto di Scienze Neurologiche e Psichiatriche dell'Infanzia e dell'Adolescenza, Via G. F. Besta, 1, 1-20161 Milan, Italy

F. Guzzetta Department of Neuropsychiatry, University of Messina, Policlinico Universitario, Via Consolare Valerio, I~98125 Messina, Italy

G. Lanzi Department of Neuropsychiatry, University of Pavia, Fondazione "C. Mondino", Via Palestro, 3, 1-27100 Pavia, Italy

R Pfanner Department of Neuropsychiatry, University of Pisa, Istituto Scientifico "Stella Maris", Via dei Giacinti, 2, 1-56018 Calambrone (Pisa), Italy