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In our practice, we frequently face patients with unfavorable prognosis. For many of us this can be frustrating, many of us may become less enthusiastic than if treating other patients with more favorable diagnosis. Life taught us that nothing is for sure. In our pediatric neurology clinic, we have faced many miracles. Some patients with congenital ataxia showed high intelligence, with no symptoms of ataxia or improvement over time. Many patients with cerebral palsy, improved with time showing fair scholastic achievement and minor motoric deficit. Several patients with Lennox Gastaut Syndrome, gain control with time with subsequent cognitive improvement…other examples
will go on and on. Many patients can surprise you; the brain itself is a great mystery. You will never know for sure what will actually happen. From my limited experience, I am telling you: Don’t give prejudgments. Deal with every patient in the same way with the same hope and expectations. Don’t use dangerous drugs or hazardous ones unless you have no other options. Don’t lose hope ever. Keep trying, search for more recent therapeutic modalities and give all chances. The sky is the limit. Duchenne has a new treatment and spinal muscular atrophy has a new therapeutic option. Be careful only in what to say to the family give the scientific explanations with proved expectations only. If there is a trial tell them and make them decide with you.