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.
- Alternating Hemiplegia of Childhood Program and Clinic
- Brachial Plexopathy Clinic
- Cerebral Palsy Clinic
- Comprehensive Neuromuscular Program
- Down Syndrome Clinic
- Epilepsy Program
- Headache Clinic
- Metabolic Treatment Program
- Neurofibromatosis Clinic
- Neurometabolic Clinic
- Spasticity Clinic
- Spina Bifida Clinic
- Tuberous Sclerosis Complex 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 firstname.lastname@example.org.
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]
Cerebral palsy (CP) is a disorder that affects muscle tone, movement, and motor skills (the ability to move in a coordinated and purposeful way). CP is usually caused by brain damage that occurs before or during a child's birth, or during the first three to five years of a child's life. Under the direction of Gordon Worley, MD, the Duke Cerebral Palsy Clinic provides multidisciplinary, comprehensive care to children with CP. Muscle tone management with medications and Botox injections are administered by attending physicians in the clinic, and appropriate patients are referred to a pediatric neurosurgeon (Herbert Fuchs, MD) for selective posterior rhizotomy and Baclofen pump insertion. In addition, patients are evaluated and treated by pediatric orthopaedic surgeons (Robert Fitch, MD and Robert Lark, MD) in the clinic. Other team members include a nurse clinician clinic coordinator (Christie Preddy), as well as an experienced social worker and physical and occupational therapists. Every effort is made to keep the number of hospital clinic visits to a minimum—it is typically possible for a patient to see three specialists during one clinic visit day. Approximately 350 children are followed in the Duke CP clinic.
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:
- 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.
- Clinical counseling, anticipatory guidance, and up-to-date, accurate information relevant to the patient’s diagnosis.
- Information regarding pertinent clinical trials and assistance with enrollment.
- Timely referral to appropriate specialists and therapists. [Read more]
The Duke Comprehensive Down Syndrome Program was developed to provide family-centered medical care for individuals with Down syndrome. Using the guidelines developed by the Down Syndrome Medical Interest Group for systematic, preventative care, our physicians work in conjunction with the patient's primary care provider. The clinic team focuses on maximizing the development of individuals with Down syndrome by managing medical issues, connecting them with community resources, and teaching families to advocate for their children. The clinic has provided specialty care to over 1,000 patients and their families since its inception in 1995.
The Duke Comprehensive Down Syndrome Program is a multidisciplinary referral clinic for the management of Down syndrome in infants, toddlers, children, and young adults. We also see expectant parents as part of our clinical services.
Our core clinical physicians and staff have expertise in Down syndrome. We provide same-day access to specialists in order to reduce the number of hospital/clinic visits for patients and their families. We can also arrange for your child to see a specialist from our ancillary services, or any physician within the Duke Health System. A coordinated approach to care allows our team to observe medical, social, and behavioral concerns common to the Down syndrome population.
Clinical research is an important component of our program. The goal of the crossdisciplinary research that occurs in our facility is to accelerate healthcare and quality of life outcomes for individuals with Down syndrome. [Read more]
Reputation for excellence. The Duke Epilepsy Center is a Level 4 Center of Excellence - the highest level of accreditation by the National Association of Epilepsy Centers. The Duke Division of Pediatric Neurology and the Duke Neurologic Disorders Programs as a whole are also consistently ranked among the top programs in the country by U.S. News & World Report.
Our doctors have also gained recognition in Castle Connolly’s Top Doctors rankings and have been honored with the Most Compassionate and Patient’s Choice Awards. The Duke Pediatric Epilepsy program averages 3,360 unique patients, 6,495 encounters, 627 new patients, 221 video LTM admissions, 2,800 separate EEG procedures and 43 surgeries [focal resection, hemispherectomies, callosotomies, and vagus nerve stimulator (VNS)] annually.
Cutting-edge technology. The Duke Pediatric Epilepsy program offers unique, cutting-edge technologies, including:
- Intraoperative MRI (iMRI), which provides real-time views of the brain during surgery and allows for the safest and most precise methods of resecting areas of the brain where seizures may occur.
- Visualase laser stereotaxic surgery, which is an advanced laser thermal ablation technique. Our neurosurgeons have been specially trained in the stereotactic neurosurgical procedure that involves inserting a thin laser fiber into the skull to precisely target areas of the brain. This allows for the performance of surgeries not previously possible and also promotes much faster recovery times.
- Multimodality 3D computerized reconstruction and coregistration to superimpose single-photon emission computerized tomography (SPECT), intracranial electroencephalogram (iEEG), magnetic resonance imaging (MRI), subdural, neuropsychological, magnetoencephalography (MEG), and other findings. This allows for enhanced localization of epileptic foci and facilitates more effective and accurate surgery
Team approach. Our experienced epilepsy specialists benefit from frequent collaborations with the following preeminent programs and services:
- Duke Department of Radiology (offering excellent tractography and fMRI)
- The Duke-UNC Brain Imaging and Analysis Center (BIAC)
- The Division of Pediatric Medical Genetics
- The Duke Center of Human Genome Variation
- Immunology and Rheumatology Programs (providing collaboration on autoimmune epilepsies)
- Pediatric Neuropsychology and Metabolic Genetic Services (including a dedicated ketogenic diet dietitian and world-renowned basic neuroscience research performed in the laboratories of James O. McNamara, MD and Mohamad Mikati, MD.
All of these programs and services collaborate in a tightly knit Translational Research Group that meets periodically to discuss problems and clinical findings. This has generated many unprecedented discoveries and novel options for therapy for patients. Similar approaches are also being applied to the use of information technology to address problems in the clinic.
Wide referral base. The Duke Pediatric Epilepsy Program has a wide referral base extending from North Carolina and throughout the United States to international locations, particularly Latin America and the Middle East. The inpatient facilities include a six-bed pediatric Epilepsy Monitoring Unit EMU (separate from the independent six-bed adult EMU). Additionally, there are capabilities to perform video EEG monitoring on the regular Pediatric floors, Step Down Units and the three ICUs (Pediatric, Neonatal and Pediatric-Cardiac) of up to 14 additional patients. The Program has three full-time epilepsy specialists (two pediatric epileptologists--Mohamad Mikati, MD and William B. Gallentine, DO, and one nurse practitioner--Lyndsey Prange, RN, who exclusively see pediatric epilepsy patients along with two epilepsy/EEG fellows and nine other clinicians. In addition, our program offers a New Onset Seizure Clinic and an Intractable Epilepsy Clinic. Other related clinics include:
- Autoimmune Encephalitis/Epilepsy Clinic
- Alternating Hemiplegia of Childhood Clinic
- Neurofibromatosis Clinic
- Cerebral Palsy Clinic
- Myelodysplasia Clinic
- Down Syndrome Clinic
All of these multidisciplinary clinics feed into our program, enhancing the referral base and management capabilities. The program is also integrated with the Adult Epilepsy Program including weekly joint epilepsy conferences with the other four, adult epileptologists and two epilepsy surgeons (one primarily an adult and the other a pediatric epilepsy surgeon).
Cutting-edge research. The Pediatric Epilepsy Program is very active in cutting edge research involving clinical studies. Our program typically conducts 15-20 protocols at any given time including drug trials, EEG monitoring and new technologies trials, prospective outcome, natural history and intervention studies as well as database studies--many of which are part national and or international consortia. Many of these studies are also performed in collaboration with other services at Duke such as the Neonatal Intensive Care Unit, Pediatric Intensive Care Unit and other leading Pediatric Epilepsy Programs throughout the country while others are being conducted exclusively at Duke. [Read more]
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.
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 (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 Comprehensive Neurofibromatosis Clinic, under the direction of Sri Guruangan, MRCP (UK), provides ongoing, specialized multidisciplinary care that is customized according to each patient’s medical, laboratory, and surgical needs. [Read more]
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 (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.
Spina bifida is a birth defect that involves the incomplete development of the spinal cord or its coverings. Spina bifida occurs at the end of the first month of pregnancy when the two sides of the embryo's spine fail to join together, leaving an open area. In some cases, the spinal cord or other membranes may push through this opening in the back. The condition usually is detected before a baby is born and treated right away. The Duke Spina Bifida Clinic provides comprehensive, multidisciplinary care for infants with spina bifida and includes pediatric neurosurgeons (Herbert Fuchs, MD and Carrie Muh, MD), pediatric urologists (John Wiener, MD and Jonathan Routh, MD), neurodevelopmental pediatricians (Gordon Worley, MD), and pediatric orthopaedists (Robert Fitch, MD and Robert Lark, MD). Also participating in the Clinic are a physical therapist with specialized expertise in spina bifida (Jan Fitch, LPT), pediatric social workers, pediatric dietetics and nutrition specialists, pediatric orthotics specialists, and pediatric occupational therapists. Cases are discussed in a combined multidisciplinary meeting during the Clinic. Approximately 450 children, young adults, and adults with spina bifida are followed in the clinic. [Read more]
Tuberous sclerosis, also called tuberous sclerosis complex (TSC), is a rare genetic disease that causes non-cancerous (benign) tumors to grow in many parts of the body, primarily in the brain, eyes, heart, kidney, skin and lungs. The signs and symptoms of tuberous sclerosis vary widely, depending on where the tumors develop and how severely a person is affected.
Tuberous sclerosis is often detected during infancy or childhood. Some people with tuberous sclerosis have mild signs and symptoms, and the condition is not diagnosed until adulthood, or it goes undiagnosed. Others experience serious disabilities, including seizures, developmental delay, intellectual disability and autism.
Although there is no cure for tuberous sclerosis, treatments are being studied, and many people who have this disease lead full, productive lives with appropriate care.
Because tuberous sclerosis can manifest in many different ways, diagnosis is generally made when any two major features of the disease are identified in one individual. One major feature is cardiac rhabdomyoma, an abnormal growth in the heart muscle generally found in young children and sometimes found by ultrasound examination during pregnancy. Other major features include specific abnormal skin growths or skin pigmentation, specific non-malignant tumors or growths such as subependymal nodules or subependymal giant cell astrocytomas (SEGAs) in the brain, lymphangioleiomyomatosis (LAM) in the lungs, angiomyolipomas in the kidney(s), and tubers in the brain or hamartomas in the eye. Also, there are other minor features of tuberous sclerosis that might be significant if found with a major feature in the same person. Tuberous sclerosis can also be diagnosed by genetic testing.
Your child may be evaluated by several different specialists, including neurologists, psychiatrists, neurosurgeons, nephrologists, hematologists, dermatologists, geneticists, cardiologists, pulmonologists, and ophthalmologists, to provide a comprehensive and tailored evaluation. In addition, this program aims to provide guidance and potential resources to the families and eventually advance knowledge of the disease to facilitate the process of discovery of new and more effective therapies.
The Duke Tuberous Sclerosis Complex Clinic meets the second Wednesday of every month in the Neurology Clinic, Third Floor, Children’s Health Center. For appointments or any other questions, please call 919-668-0477.
Physicians and Staff
|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|
|Arsen Hunanyan, PhD||Post-Doctoral Associate|
|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)|
|Joselle Claudio, LPN|
|Lyndsey Prange, RN, MSN, CPNP||Nurse Practitioner - Epilepsy|
|Elizabeth Rende, DNP, RN, CPNP||Nurse Practitioner - Headaches|
|Tosha Swinney, LPN||Clinical Coordinator|
|Kimberly Bradsher||Medical Secretary|
|Karen Cornett||Clinical Research Coordinator|
|LaTonya Fields||Medical Secretary|
|Diane Gupton||Medical Secretary|
|Kristin Johnson||GME Program Coordinator|
|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
Hours: Daily, 8:00am - 4:30pm
Duke Children’s and WakeMed Children's Specialty Services
23 Sunnybrook Road, Suite 200
Raleigh, NC 27610
Hours: Monday - Friday, 8:00 am - 5:00 pm
Lenox Baker Children's Hospital
3000 Erwin Road
Durham, NC 27705
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
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).
Duke Children's Ranked for Top Pediatric Care
Nationally recognized by U.S. News & World Report as one of the best pediatric neurology programs, we are dedicated to innovative, compassionate and life-changing care for all children. [Learn more]
- Solving the Mystery of Epilepsy [PDF, 240KB]
- Pediatric Division of Neurology
(Duke School of Medicine)
- Pediatric Clinical Trials (Neurology)
- Duke Autism Clinic
- Duke Neurofibromatosis Clinic
- Duke Brachial Plexopathy Clinic
- Duke Comprehensive Neuromuscular Program
- Dietary Therapy for Epilepsy