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.

Top of Page

Treatments

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.

If your child is affected by OBP, please feel free to contact us for further information at 919-684-4721. To schedule an appointment, please call: 919-684-4721.  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 Health System 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.

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.

Neuromuscular Clinic

Neuromuscular diseases are a large group of disorders with various causes sharing one common feature: weakness. One large group of neuromuscular diseases is caused by abnormalities in the nerves as they exit the brainstem and spinal cord and travel out to their respective muscles. These are called “neuropathies.” Common examples in this group include spinal muscular atrophy and Charcot-Marie-Tooth disease. Another large group of neuromuscular diseases, the “myopathies”, are caused by abnormalities in the muscle tissue. Some of the more common examples include Duchenne muscular dystrophy and myotonic dystrophy. A less common cause of neuromuscular weakness are the disorders of neuromuscular transmission. These are caused by abnormalities at the spot where the nerve attaches to the muscle. Examples of disorders of neuromuscular transmission include myasthenia gravis and botulism.  

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 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.

The Duke Pediatric Neuromuscular Clinic is directed by Edward C. Smith, MD. Dr. Smith completed a child neurology residency and a neuromuscular medicine fellowship at Duke. The clinic meets every Monday afternoon from 1:00pm to 5:00pm at the Lenox Baker Children’s Hospital. Please call 919-668-0477 to schedule an appointment.

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.

Top of Page

Physicians and Staff

Physicians

Staff

Top of Page

Clinic Hours and Location

Hours: Daily, 8:00am - 4:30pm

Hours: Monday and Tuesday, 1:00pm - 5:00pm
Wednesday, 9:00am - 12:00pm

Hours: Daily, 8:00am - 4:30pm

Top of Page

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).

Top of Page