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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]


Cerebral Palsy Clinic

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. 


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]

Down Syndrome Clinic

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]


Epilepsy Program

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:

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]


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.


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.


Spina Bifida Clinic

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]


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
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
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).