Hospital News
Neurology
Our Expertise
The Division of Pediatric Neurology provides comprehensive services for:
- Epilepsy
- Spasticity
- Spina bifida
- Pediatric neuromuscular diseases, including muscular dystrophy and spinal muscular atrophy
- Metabolic and genetic diseases
- Autism and related disorders
Our neurologists also care for children with cerebral palsy, movement disorders, and chronic headache, and participate in the treatment of children with head and spinal trauma, as well as brain and spinal cord tumors in collaboration with our pediatric neurosurgeons.
Special programs and services include:
Pediatric Epilepsy Center
The Pediatric Epilepsy Center of Morgan Stanley Children's Hospital draws on the close collaboration between pediatric neurologists and pediatric neurosurgeons, as well as the resources of the adult neurology department of NewYork-Presbyterian/Columbia to treat all types of seizure disorders. It is one of the most active pediatric epilepsy programs on the East Coast and is a major referral program for the treatment of intractable seizures.
A disruption in the brains electrical impulses, epilepsy is characterized by recurrent unprovoked seizures. Chronic epilepsy can have severe effects on the developing brain, and that is why surgical treatment in children may be recommended for children following careful evaluation.
Our neurologists utilize highly sophisticated diagnostic techniques, including video-electroencephalography (EEG) monitoring and biochemical and imaging modalities, to evaluate children with seizure disorders. Our technologists are particularly skilled in working with children to help alleviate anxieties connected with the procedures.
Our six-bed inpatient Pediatric Epilepsy Monitoring Unit, which serves nearly 400 patients a year, enables us to perform the testing necessary to confirm a diagnosis and determine appropriate medical management. Here patients are monitored by video-electroencephalography (EEG), with access to imaging studies that include high-resolution MRI, ictal single photon emission computed tomography (SPECT), and positron emission tomography (PET). These brain mapping studies enable us to identify the specific area of the brain involved in seizure onset. We also use neuropsychological testing to uncover possible memory and cognitive changes.
In all cases, therapy is tailored to the individual child, and treatment options may include the full range of anti-epileptic medications, the ketogenic diet and vagus nerve stimulation. Some children benefit from surgery, which is guided by sophisticated brain mapping techniques. Once the focus of the seizure is pinpointed, our neurosurgeons can safely remove the involved portion of the brain. Infants and children's brains are more plastic than an adult's. In other words, an injury or operation that might lead to significant dysfunction in a adult generally has a better outcome in children, where uninvolved areas of the brain have the capacity to take over some functions of the injured region.
We continue to explore new anti-epileptic medications, neural monitoring technologies, and implantable stimulation devices. In addition, an implantable miniaturized monitoring system that records the abnormal electrical activity of individual neurons involved in epilepsy is also under study.
Spasticity Center
The Spasticity Center at Morgan Stanley Children's Hospital is a multidisciplinary program that includes pediatric specialists in neurology, neurosurgery, orthopedic surgery, physical and occupational therapy. Spasticity results from damage to the motor pathways of the brain or spinal cord. It is characterized by stiff muscles and exaggerated reflexes that can interfere with gait, movement, or speech. Symptoms and signs may include scissoring or crossing of the legs, clonus (repetitive jerking of the ankles or other joints with minimal stimulation) and posturing of the limbs. Typically, the upper extremity is flexed and the lower extremity is extended. Chronic untreated spasticity can lead to muscle contractures.
Our healthcare team provides consultation and treatment services during a single visit, avoiding the need for multiple appointments over several months. Patients undergo a thorough examination to determine the optimum management plan for their particular condition. This may involve a combination of physical and occupational therapy (including positioning, bracing, splinting, and casting), Botox intramuscular injections, Baclofen and other oral medications or Baclofen pumps that are implanted under the skin to dispense medication directly into the spinal fluid. In some cases neurologic or orthopedic surgery is required for an optimal outcome.
Our Spasticity Center is the only program in the tri-state area and among the few nationwide that performs minimally invasive selective dorsal rhizotomy to relieve spasticity due to cerebral palsy. Traditionally this operation involved removing five levels of bone during an eight-hour surgery. Today, our surgeons remove just one level of bone through a minimally invasive approach. The operation is much quicker and children recover faster, allowing them to begin the process of retraining their relaxed muscles with physical therapy and rehabilitation at an earlier stage.Pediatric Neuromuscular Diseases
We offer programs for pediatric neuromuscular diseases that bring together experienced clinicians and researchers to tackle these challenging conditions. Translating work in the lab to the clinic, our group is pursuing natural history studies and developing experimental therapies. Among our specialty programs for neuromuscular disease are: Pediatric Muscular Dystrophy Association Program Muscular dystrophy is a group of more than 30 genetic diseases that cause progressive weakness and degeneration of the muscles used during voluntary movement. These inherited disorders can vary in age of onset, muscles affected and level of severity.
Our program is an affiliated clinic of the National Muscular Dystrophy Association. Our young patients benefit from our specialized expertise in these disorders, as well as their access to the care of physiatrists, orthopedists, and therapists who work collaboratively with a neurologist to maintain or to restore muscle function. Our goal is to improve a patients ability to perform daily activities and to promote the highest functioning possible, support independence and maintain quality of life.
Spinal Muscular Atrophy Clinic
Spinal muscular atrophy is a genetic disease causing a loss of motor neurons, the nerve cells in the spinal cord. First appearing in children between the ages of 6 and 18 months, spinal muscular atrophy generally presents with severe weakness in the muscles of the shoulders, hips, thighs and upper back. Respiratory muscles can also be involved.
A new clinic and research network is enabling our physicians to provide state-of-the-art care to children with this disorder, as well as fostering the implementation of clinical trials for new treatments. A Pediatric Neuromuscular Clinical Research (PNCR) network for spinal muscular atrophy is based at Columbia University, with one of its clinical sites at Morgan Stanley Childrens Hospital.
Metabolic Disorders
Our pediatric neurologists have years of experience caring for children with inborn errors of metabolisma class of genetic diseases in which an inherited defect (usually a missing or inadequate enzyme) results in an abnormality of metabolism that involves the nervous system. These include Tay-Sachs disease, first described by Bernard Sachs, MD, who established the child neurology division here in 1934. Our physicians continue to be at the forefront of knowledge concerning mitochondrial diseasea progressive genetic disorder that occurs when the mitochondrial of the cell fail. Mitochondria are tiny organelles found in almost every cell in the body and are responsible for creating more than 90 percent of cellular energy that is necessary to sustain life and support growth.
We also treat and study glucose transporter deficiency, lysosomal storage diseases, disorders of nervous system development, and congenital disorders of glycosylation (CDG). Many of these disorders, including glucose transporter deficiency, co-enzyme Q-10 deficiency and some forms of CDG, were first described by our physicians and continue to be studied here. Co-enzyme Q10 (CoQ10) is a family of inherited disorders in which the enzymes responsible for synthesizing that compound are deficient. Because CoQ10 is required for normal functioning of the mitochondria, it can produce a variety of different symptoms involving the muscles, the brain, or both, and lead to unsteady gait ataxia and seizures.
In addition, we are investigating a novel treatment for lysosomal storage diseases by conducting an international study of the drug miglustat with a center in the United Kingdom for the treatment of Niemann-Pick disease, type C The results of this study in this previously untreatable disease are promising, and the study has also provided much useful information that will improve the care of children and adults affected by this disease.
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