Department of Pediatrics

Child Neurology and Neurodevelopmental Disabilities Subspecialty Service Electives

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Listed below are descriptions of some of the subspecialty electives for residents. Beyond those listed below, residents may additionally choose electives in a variety of other areas to include related services, such as Neurosurgery, Neuro-ophthalmology, Neuromuscular Neurophysiology, Palliative Care, and many others. All of the programs offer the potential for residents to participate in ongoing clinical research and/or develop a project related to the extensive population of patients seen by these services.

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Neuro-Oncology

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Residents rotating on neuro-oncology will see patients with pediatric central and peripheral nervous system tumors as well as neurological complications of cancer. Residents will also see patients with neurocutaneous conditions, specifically neurofibromatosis and tuberous sclerosis. During this rotation, residents are involved in the multi-disciplinary approach to care for these patients and interact with other subspecialists: neurosurgery, neuroradiology, radiation oncology, oncology, ophthalmology, pathology, physical medicine and rehabilitation.

Upon completion of this rotation, residents should be familiar with the principles of diagnosis and management of primary and secondary central and peripheral nervous system neoplasms, acute and long-term neurologic complications of cancer and related disorders (direct cancer related toxicity and indirect neurologic effects of treatment), side effects of treatments and supportive care measures. In addition, they should be familiar with hereditary disorders that predispose to CNS tumors.

Texas Children's has one of the larger neuro-oncology programs, with about 150 new CNS tumors diagnosed each year. We participate in many different consortiums and provide our patients unique clinical trial opportunities, in addition to a comprehensive multidisciplinary team approach to care. The Texas Children's Brain Tumor program is a leader in research and provides personalized medicine for all patients, with the potential for greater efficacy and fewer side effects.

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Pediatric Multiple Sclerosis and Neuroimmunology

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Residents rotating on the Pediatric Multiple Sclerosis and Neuroimmunology service will see patients with conditions such as ADEM, multiple sclerosis, neuromyelitis optica, OMA, autoimmune encephalitis and other immune related CNS disease. Our service is unique in that we see and help manage these patients during their acute admissions and continue to follow them in our outpatient Pediatric Multiple Sclerosis and Neuroimmunology Clinic. Residents will learn diagnostic criteria for these conditions and learn initial and chronic management of these patients.

A fellowship is available at Texas Children’s Hospital for this subspecialty.

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Pediatric Sleep Medicine

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The Pediatric Sleep Medicine elective offers a unique experience exploring the full range of sleep problems ranging from insomnia, narcolepsy, periodic leg movements/Restless leg syndrome, parasomnias and sleep disorder breathing experienced by children from birth to early adulthood, typically developing as well as those with neurological disorders, autism, and neuromuscular disorders, and epilepsy. This experience includes the diagnostic laboratory--overnight sleep studies, daytime Multiple Sleep Latency Test and actigraphy--and the clinic--diagnosis and management---as well as sleep medicine journal club, case presentations and didactic lectures. The Sleep Center is based in child neurology and neurophysiology and so is very pertinent to the child neurology resident.

A fellowship is available at Texas Children’s Hospital for this subspecialty.

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Neurogenetics

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Residents rotating in neurogenetics can take advantage of the tremendous breadth of genetics expertise at Texas Children’s Hospital and Baylor College of Medicine. Along with focused neurogenetics clinics, residents additionally attend clinical conferences and didactic sessions to provide them with a strong foundational knowledge in the basics of genetics, indication and interpretation of state-of-the-art genetic testing, and aspects of clinical diagnosis and care for patients with neurogenetic conditions.

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Pediatric Movement Disorders

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Working with subspecialty faculty, residents rotating in the Pediatric Movement Disorders Clinic will see patients with tics, dystonia, tremor, myoclonus and other involuntary movements, and learn how best to evaluate and treat them. Rotators will have exposure to treatment modalities including botulinum toxin injections and deep brain stimulation programming. They will have the opportunity to attend weekly video rounds and monthly multi-disciplinary clinic, during the latter of which they will have collaborative interactions with other services including Physical Medicine and Rehabilitation, Neurosurgery and Orthopedics.

A fellowship is available at Texas Children’s Hospital for this subspecialty.

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Comprehensive Tuberous Sclerosis Clinic

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Working with our multidisciplinary TSC team, residents will familiarize themselves with the diagnostic workup and surveillance of children with Tuberous Sclerosis Complex. This outpatient clinic includes an epileptologist, neuro-oncologist, neurogeneticist and developmental pediatrician. Residents will be introduced to the management of epilepsy and medically refractory patients including epilepsy surgical evaluations, utility of genetic testing and family implications and common comorbidities such as ADHD, Intellectual disability and Autism. We communicate closely with our nephrologist, cardiologist and ophthalmologist who see our patients off-site. This is an exciting clinic for anyone interested in how to coordinate multi-specialty care in a complex disease.

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Stroke and Cerebrovascular Disorders

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Residents rotating on this service will be able to see neonatal and pediatric patients with acute and chronic cerebrovascular disorders including ischemic and hemorrhagic stroke, cerebral sinovenous thrombosis, arterial dissection and other vasculopathies like Moyamoya disease. They will learn about the acute management, rehabilitation phase and long-term prognosis of these patients.

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Pediatric Headache

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Working with board certified headache specialists at Texas Children's Hospital community campuses, residents rotating on this service will learn and assimilate various outpatient preventive and acute therapies for pediatric headache management. Exposure includes: elements of a comprehensive headache history, diagnostic approaches to include history, physical exam, imaging, acute and preventive headache therapies, procedures including occipital nerve blocks, SPG blocks, and Botox therapy, and research opportunities. Tailored interests include Neuro-ophthalmology, Psychology, Physical Therapy, Adult headache, and Pain Clinic.

A fellowship is available at Texas Children’s Hospital for this subspecialty.

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Pediatric Neuromuscular Disease

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Residents work with pediatric and adult neuromuscular specialists at Texas Children’s Hospital and Baylor College of Medicine. Texas Children’s Hospital has one of the largest neuromuscular programs in the country with three large clinics per week to include a multi-disciplinary clinic where residents work alongside specialists from Cardiology, Pulmonary Medicine, Physical Medicine and Rehabilitation, Palliative Care, Orthopedics, and Endocrinology as well as Neuropsychology, Nutrition Services, Social Work, and Physical Therapy. Residents will learn key aspects of taking a history and performing an examination on a child affected with a neuromuscular disease as well as aspects of long-term care. Texas Children’s Hospital utilizes state-of-the-art gene therapy and other treatments for patients with neuromuscular conditions, allowing residents to become familiar with the indications and use for such therapies.

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Neurodevelopmental Disabilities

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Given the high prevalence of neurodevelopmental disorders, the integration of neurological and developmental and/or behavioral manifestations of neurological disease, and the prominence of evaluation and management of these conditions in the typical general child neurology clinical practice, a rotation focused specifically on neurodevelopmental disabilities offers additional training in this critical area of our field. 

Residents will have the opportunity to work with our enthusiastic faculty in neurodevelopmental disabilities, development and behavior pediatrics, neuropsychology, psychology, and psychiatry.  

In addition to diagnosis and treatment of common neurodevelopmental disorders, this rotation will help guide critical thinking about more complex symptoms and patient courses.  Learning simple developmental and behavioral assessment tools to better elucidate the proper diagnosis is incorporated into each clinical experience. A better understanding of “outcomes” (both clinically and as reported in the literature) is another important component of this rotation. Whether you work want to work in private practice or develop an academic center, focus on general neurology or a neurological subspecialty, confidence in the evaluation and management of neurodevelopmental disabilities will only enhance your ability to provide comprehensive care for your patients. 

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Epilepsy

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Residents who rotate through the epilepsy rotation will gain experience with the diagnostic work up and management of children with refractory epilepsy in both an outpatient and inpatient setting. Outpatient settings include specialty clinics dedicated to patients with infantile spasms, Dravet Syndrome, Tuberous Sclerosis clinic and those undergoing the ketogenic diet. Inpatient settings include elective admissions in the epilepsy monitoring unit, where patients undergo both spell characterization and evaluation for epilepsy surgery. Texas Children's Hospital features a 12-bed epilepsy monitoring unit, with real-time monitoring by a team of technologists 24 hours a day. Residents will be exposed to invasive (intracranial) monitoring with subdural grid/strip and stereo-EEG electrodes which aid in formulating surgical plans for laser ablation and/or resective epilepsy surgeries. Finally, through the epilepsy consult service, they will participate in the medical and surgical management of patients in the neurocritical care unit on continuous EEG-video.

A fellowship is available at Texas Children’s Hospital for this subspecialty.