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Neurology

Evaluating and treating the whole child, and family, with neurological conditions.


The Division of Pediatric Neurology serves patients with diseases of the brain, peripheral nervous system (nerves), and muscles. The division's faculty and staff include four pediatric neurologists, three pediatric neurology fellows, two nurse practitioners, and four clerical assistants. Due to the nature of our patient's conditions, we also work closely with members of other divisions including Adult Neurology, Child Development and Behavioral Health, Developmental Pediatrics, Medical Genetics, Neuropsychology, and Neurosurgery.

To further medical knowledge and offer our patients cutting-edge treatments, members of the division participate in research sponsored by the NIH, pharmaceutical industry, and private foundations. We also participate in medical student and resident education through clerkships and other clinical experiences. Finally, our faculty members are regular contributors to the medical literature.


Treatments


Alternating Hemiplegia of Childhood Multidisciplinary Program and Clinic

Alternating Hemiplegia of Childhood is a potentially debilitating childhood disorder that can cause episodes of paralysis on either or both sides of the body, painful muscle contractions of the extremities, abnormal eye movements, difficulty in coordination, developmental difficulties, behavioral problems, epileptic seizures, sleep disorders, and rarely potentially serious life threatening events. The Duke Alternating Hemiplegia program brings together specialists from various disciplines related to the above problems to provide comprehensive and tailored evaluations of the problems of these children to help them and their families better identify the problems they have and manage not only the hemiplegia episodes with the appropriate medication therapy but also to treat the many problems that typically occur concurrently with the hemiplegia episodes.

In addition, this program aims to provide guidance and potential resources to the families and to eventually advance knowledge of the disease to facilitate the process of discovery of new and more effective therapies. For appointments or any other questions, please call 919-668-6751 or email dukeahc@dm.duke.edu


Brachial Plexopathy Clinic

The Duke Pediatric Brachial Plexopathy Clinic was started to offer coordinated care for children with obstetric brachial plexopathy (OBP) who are not recovering function spontaneously. One of our goals is to determine as early as possible which children are not going to recover adequate function on their own and whether or not surgery is a good option for them. This requires a coordinated approach involving multiple medical specialties, including pediatric neurology, neurosurgery, orthopedics and occupational therapy.

There are many unanswered questions regarding OBP, and our clinic also serves a research purpose. We would like to not only answer which children might benefit from surgery, but how soon should surgery be done? What type of surgery is most effective and carries the least risk? What are the most reliable tools available to help the doctor accurately counsel parents regarding prognosis? Are there effective non-surgical therapies beyond traditional physical or occupational therapy? Hopefully, by following enough children over a long enough period of time we will be able to begin to answer some of these questions more accurately. [Read more]


Comprehensive Neuromuscular Program

The needs of children with neuromuscular diseases are variable and frequently require coordinated care through a number of specialists. The child neurologist plays a key role in the ongoing assessment of disease progression as well as functioning as the “go-to person” with regard to coordination of care with other specialists. If the child has respiratory weakness, visits with a pulmonologist may be necessary.  For this reason, the Duke Pediatric Neuromuscular Clinic was created.   

The mission of the Duke Pediatric Neuromuscular Clinic, under the co-direction of Edward C. Smith, MD and Richard Kravitz, MD, is to offer exceptional care to children with neuromuscular disorders by providing:

  1. State-of-the-art diagnostic evaluations and therapy for patients with pediatric neuromuscular disorders in a timely manner. This may include specialized laboratory studies, electromyography and muscle biopsy.
  2. Clinical counseling, anticipatory guidance, and up-to-date, accurate information relevant to the patient’s diagnosis.
  3. Information regarding pertinent clinical trials and assistance with enrollment.
  4. Timely referral to appropriate specialists and therapists. [Read more]

Epilepsy Clinic

Seizures and other paroxysmal disorders are the most common clinical problems encountered by the Pediatric Neurologist. Our Epilepsy Clinic is designed to provide special expertise for both the medical and surgical treatment of childhood seizure disorders. Duke University Medical Center has an outstanding medical and surgical epilepsy team and a strong basic science epilepsy program with international recognition. Mohamad Mikati, MD, one of the Epilepsy Clinic attending physicians, is widely recognized for his clinical and research efforts in pediatric epilepsy. William Gallentine, DO, also sees patients in the Epilepsy Clinic. To schedule an appointment, please call: 919-668-0477.


Metabolic Treatment Program

Dietary therapy is a recognized treatment for epilepsy in children and is offered by Duke Children’s Hospital & Health Center. Doctors usually recommend dietary therapy for children whose seizures have not responded to two or more different types of seizure medications or whose medications are causing severe side effects. Although dietary therapy does not work for every child, it can produce dramatic results in some children.

All forms of dietary therapy for epilepsy involve restricting carbohydrates and increasing fat in the diet. The traditional ketogenic diet, in which about 90% of the calories in the diet come from fat, has been used to treat epilepsy since the 1920s with significant success. More recently, less restrictive diets, including the modified Atkins diet, the medium-chain triglyceride (MCT) diet, and the low glycemic index treatment (LGIT), that allow for a wider range of foods have been developed.
[Read more]


Headache Clinic

Acute, recurrent headaches affect approximately 10% of the pediatric population, causing the potential for significant disability to the child and family. Home, school and social environments are also affected by these headaches. The majority of the acute, recurrent headaches identified in children meet established criteria for "migraine headache." Another less common headache type seen in children is "tension headache." Once a secondary cause for the headaches has been excluded, an aggressive management approach is initiated. Members of the Pediatric Headache Clinic use the latest medical information available to recommend prophylactic and episodic medications to treat the child with headache. In addition, and based on each patient’s circumstances, complementary approaches such as the use of biofeedback or other biobehavioral strategies may be recommended. The outcome of this multifaceted approach is a child with fewer headaches, and improved quality of life.


Neurofibromatosis Clinic

Neurofibromatosis (NF), one of the most common genetic disorders, is characterized by the formation of tumors involving nerve tissue in the skin, subcutaneous tissue, cranial nerves, and spinal root nerves. Other abnormalities can develop in the skin and bones. The symptoms of NF can be varied and evolve over time.  Because of the progressive nature of these conditions, the Duke Neurofibromatosis Clinic, under the direction of Mohamad Mikati, MD, provides ongoing, specialized multidisciplinary care that is customized according to each patient’s medical, laboratory, and surgical needs.

This clinic was established in January 2007 as the first multidisciplinary neurofibromatosis clinic at Duke University Medical Center. The clinic began with one full Thursday clinic per month but the hours will be expanding to every Thursday due to increasing patient volume. The clinic is located in the McGovern-Davison Children’s Health Center, a state-of-the-art facility adjacent to Duke Hospital and is in close proximity to imaging resources of the Medical Center, including computed tomography (CT), magnetic resonance imaging (MRI), and positron emission tomography (PET). The clinic is also in close proximity to the neurophysiology lab where electroencephalograms (EEG), evoked potentials and electromyograms ( EMG) are performed. The Duke Neurofibromatosis Clinic is dedicated to outpatient medical and surgical specialty care to individuals with neurofibromatosis, type 1 and type 2. [Read more]


Neurometabolic Clinic

The goal of the Neurometabolic Clinic is to serve as a diagnostic clinic focused on the evaluation of children with unexplained developmental regression or delay. This clinic involves a multidisciplinary approach focused on assessment for metabolic disorders, neurodegenerative conditions, and chromosomal abnormalities.


Spasticity Clinic

Spasticity (muscle tightness) commonly occurs in children who have suffered brain damage. The severity of the injury determines the degree of spasticity, with some children being severely affected and wheelchair-bound. Others children may be mildly spastic with only a complaint of toe walking because of tight calf muscles.    

Spasticity makes it difficult for children to perform fine motor tasks, such as writing, and causes problems with balance and walking. Spasticity can interfere with daily activities and, in more severe cases, cause significant pain and pull joints out of alignment. Although oftentimes the disorder causing spasticity is not progressive, the consequences of muscle spasms may worsen over time as a child grows.   

Ideally, the treatment of spasticity is provided by a multidisciplinary team including a neurologist, orthopedic surgeon, neurosurgeon, physical therapist, and occupational therapist. Social workers and dieticians often play an important role as well. The patient’s condition determines which team members have more prominent a role. 

The management of spasticity is multi-faceted. Depending on the particular patient, a combination of pharmacological, therapeutic and surgical approaches may be required:

  • Pharmacological options include oral medications to reduce spasticity. Other options include botulinum toxin injections into muscles and intrathecal baclofen pumps.
  • T herapeutic options include a wide range of interventions offered by physical, occupational and speech therapists.
  • Surgical interventions to lengthen muscles and tendons can be very beneficial for certain patients.

The Duke Pediatric Spasticity Clinic meets every Wednesday afternoon from 1:00pm to 5:00pm at the Lenox Baker Children’s Hospital and offers access to all of these treatment options. To schedule an appointment, call 919-668-0477.


Physicians and Staff

Physicians

Name Areas of Special Interest
William B. Gallentine, DO Epilepsy, epilepsy surgery, neurometabolic and neurodegenerative disorders
Sujay Kansagra, MD Pediatric sleep disorders, with particular interest in hypersomnia disorders such as narcolepsy, Klein-Levine Syndrome, and idiopathic hypersomnia; polysomnography interpretation
Mohamad A. Mikati, MD Intractable epilepsy and epileptic encephalopathies, presurgical evaluation for epilepsy surgery, development and testing of new antiepileptic drugs, application of new MRI techniques in epilepsy, general pediatric neurology
Carolyn E. Pizoli, MD, PhD General pediatric neurology; acquired and traumatic brain injuries, including concussion, infection, stroke
Edward C. Smith, MD General child neurology with special interest in neuromuscular disorders, brachial plexus injuries, cerebral palsy
Gordon Worley, MD Evaluation and treatment of children with cerebral palsy, spina bifida, Down syndrome

Staff

NameRole
Research Associate
Arsen Hunanyan, PhD Post-Doctoral Associate
Residents
Abeer Hani, MD Third Year Resident
Roha Khalid, MD Second Year Resident
Kathryn Xixis, MD Second Year Resident
Eric Arehart, MD, PhD First Year Resident
Sarah B. Neuhaus, MD First Year Resident
Rhaul Sinha, MD First Year Resident (starting July 1, 2014)
Dmitry Tchapyjnikov, MD First Year Resident (starting July 1, 2014)
Nursing Staff
Joselle Claudio, LPN
Lyndsey Prange, RN, MSN, CPNP Nurse Practitioner - Epilepsy
Elizabeth Rende, DNP, RN, CPNP Nurse Practitioner - Headaches
Tosha Swinney, LPN Clinical Coordinator
Administrative Staff
Kimberly Bradsher Medical Secretary
Karen Cornett Clinical Research Coordinator
LaTonya Fields Medical Secretary
Diane Gupton Medical Secretary
Lindsay Johnson Staff Assistant
Deborah Ladd Medical Secretary
Peter Malinosky Administrative Manager


Clinic Hours and Locations

Duke Children's Hospital & Health Center
Neurology Clinic, Third Floor
2301 Erwin Road
Durham, NC 27705
Tel: 919-668-0477
Hours: Daily, 8:00am - 4:30pm 

Duke Children’s and WakeMed Children's Specialty Services
23 Sunnybrook Road, Suite 200
Raleigh, NC 27610
Tel: 919-862-1200
Hours: Monday - Friday, 8:00 am - 5:00 pm

Lenox Baker Children's Hospital
Neurology Clinic
3000 Erwin Road
Durham, NC 27705
Tel: 919-664-6669
Hours: Monday and Tuesday, 1:00pm - 5:00pm
Wednesday, 9:00am - 12pm 

Duke EMG Lab
Duke South Clinics, 1L
200 Trent Drive
Durham, NC 27705
Tel: 919-668-7600
Hours: Daily, 8:00am - 4:30pm


Appointments and Contact Information

All patients must be referred by their primary care provider. To serve our patients and referring physicians, faculty physicians covering pediatric neurology are always on call to answer questions and provide consultation.

  • For new and return appointments, prescription refills, or to speak with a nurse, call 919-668-0477.
  • For urgent calls after business hours, on weekends, or on holidays, please call 919-684-8111 and ask the operator to page the pediatric neuology resident on call.
  • For physicians requesting consultations or making referrals, please call the Duke Consultation and Referral Center at 800-MED-DUKE (800-633-3853).