Child Neurology

Goals and Philosophy

The Child Neurology Residency Program shall provide a foundation for the resident who will specialize in the discipline of Pediatric Neurology and any of its subspecialties. The program shall expose the resident to a variety of clinical experiences, which will help him/her develop the skills necessary to diagnose and treat primary neurological disorders as well as the neurological complications of medical and surgical conditions in the adult and pediatric age groups.

The program shall also provide an academic environment and foster an atmosphere conducive to the development of clinical and basic science research. An important part of the program will be the development of specific skills in the area of neurological diagnostic testing including neuroradiology, EEG, EMG, sleep disorders, skin biopsy and lumbar puncture. At the conclusion of the program, the resident will be prepared for the autonomous practice of pediatric neurology in an academic or private practice environment.

Education

Our program consists of one year of adult neurology at our affiliated Hahnemann Hospital program and two years of Child Neurology at St. Christopher’s Hospital for Children. At least two years of pediatrics need to be completed prior to starting the adult neurology year. During the two years of pediatric neurology, the resident will master the skills to obtain a history and perform a complete pediatric neurological examination. Special attention should be given to the difference in examination by age, milestones, growth patterns and behavior.

The resident will also be able to develop a differential diagnosis and treatment plan with particular emphasis on metabolic and congenital disorders. He/she will participate in at least six months of inpatient service as well as selected longitudinal clinics. The resident will make management decisions regarding patient care after careful discussion with the attending physician on inpatient service. The resident should develop proficiency in lumbar punctures in children.

He/she will participate in at least two months of rotations in EEG, EMG, sleep medicine and neuroradiology and develop a proficiency in interpretation of EEG and EMG studies.

The resident will also participate in specialty clinics including Metabolic, Neuromuscular, Refractory Epilepsy, Sleep Disorders and PKU. The fellows have exposure to invasive epilepsy surgery with grids and strips.

The resident will participate in six months of inpatient child neurology service where the resident provides the primary management of the patients with the supervision by the attending physician. Faculty members with different areas of expertise are available to the Child Neurology Fellows. St. Christopher’s Hospital for Children offers a very friendly environment, which is conducive for learning.

The Pediatric Residency Program at St. Christopher's Hospital for Children has expanded to include two (2-year) pediatric positions annually for child neurology candidates and two (1-year) pediatric positions to accommodate the specialties requiring a clinical base year. These preliminary year positions are listed in FRIEDA and recruitment will occur within the National Residency Matching Program (NRMP) under separate match numbers.

As with our current categorical pediatric residents, there will be biannual evaluations as well as monthly evaluations, which will be handled similarly. Continuity clinic will be a half-day each week per resident.

SAMPLE BLOCK ROTATIONS/ANNUAL SCHEDULE FOR FELLOWS, PL1 AND PL2
(General Pediatrics, St. Christopher’s Hospital for Children)

* supervisory role

IP=Inpatient Medicine AD=Adolescent Medicine

IPsub=Inpatient Subspecialty DEV=Developmental Pediatrics

ER=Emergency Room EL=Elective

NICU=Neonatal Intensive Care ELs=Elective Subspecialty

WB=Well Baby Nursery PICU=Ped Intensive Care

GP=General Peds Sick Clinic Vac=Vacation

SAMPLE BLOCK ROTATIONS/ANNUAL SCHEDULE FOR FELLOWS, PL 3
(Adult Neurology, Hahneman University Hospital)

SAMPLE BLOCK ROTATIONS/ANNUAL SCHEDULE FOR FELLOWS, PL4 AND PL5
(Child Neurology, St. Christopher’s Hospital for Children)

PL 4

PL5

Inpatient Rotation (PL 4 and PL5)

The Section of Neurology has a responsibility to provide the best possible care for the patients that we serve on the inpatient units at St. Christopher’s Hospital for Children. Patients admitted for evaluation and treatment of pediatric neurological problems requires inpatient care that is comprehensive, cost-effective and compassionate. To this end, the child neurology resident on the hospital inpatient service will develop competence at inpatient management for a variety of neuropediatric conditions. The resident must also develop skill at teaching medical students. The resident is expected to have developed basic neurologic knowledge, good clinical judgment and excellent clinical exam skills.

During the last year of training (third year of residency), the resident must move to the next level (competence) in all areas, assuming a more supervisory role of junior residents and medical students, with a focus on greater independence in medical decision making. The third year resident must develop sufficient leadership skills to manage all aspects of the inpatient neurology service at St. Christopher’s.

The inpatient team is comprised of the neurology attending, Child neurology fellow, 0-1 neurology or pediatric resident and 1-2 medical students.

The inpatient area at St. Christopher’s Hospital consists of 189 beds. There are two video EEG unit rooms on the hospital floors, one video EEG unit in ICU, 1 video EEG unit in Special Care Unit and 1 video EEG unit in the NICU. The hospital has a 16-bed ICU/CCU, 18-bed Special Care Unit/Burn Unit, 40 bed NICU/Continuing Care Nursery and 7 beds in the Oncology Transplant Unit. Consults from all these areas are expected.

Average inpatient neurology census is 2-4 patients on service, 1-3 consults per day and 1-3 follow-up consults per day.

Outpatient Rotation (PL4 and PL5)

The Section of Neurology has a number of specialty clinics that allow the child neurology resident to broaden the scope and increase the depth of his/her outpatient experience. The resident will see common and uncommon diagnoses concentrated within our tertiary care subspecialty clinics, and can see the entire spectrum of a disease via interactions with multiple patients at different time points in the same disease.

The resident will be assigned to work with one attending in their clinic during each half day of this rotation. The attending may wish the resident to observe clinical interactions or may ask the resident to first see patients independently and then discuss with the attending thereafter. The degree of independence allowed to each resident will be determined by the attending and agreed upon by the resident, although it is expected that the degree of independence will increase with increasing seniority in the residency program.

Current child neurology specialty clinics at St. Christopher’s Hospital include metabolic, neuromuscular diseases, intractable epilepsy, sleep and the PKU clinic.

In the Section of Neurology, we have seven examination rooms available, and two testing rooms for neuropsychological evaluations. The Neurodiagnostic lab has five exam rooms performing EEGs, EMG and evoked potentials. Up to six sleep studies can be performed each night in the lab.

Research

Clinical and basic research opportunities are available during the training. A research project is required including the publication of two manuscripts and presentation in at least one national meeting. Some recent examples of publications by our fellows are below.

Recent Publications by Fellows

Ezugha H, Anderson CE, Marks HG, Khurana D, Legido A, Valencia I.
Microarray analysis in children with developmental disorder or epilepsy.
Pediatr Neurol. 2010 Dec;43(6):391-4.

Ezugha H, Goldenthal M, Valencia I, Anderson CE, Legido A, Marks H.
2.5q14.3 deletion manifesting as mitochondrial disease and autism: case report.
J Child Neurol. 2010 Oct;25(10):1232-5.

Cruz MJ, Valencia I, Legido A, Kothare SV, Khurana DS, Yum S, Hardison HH, Melvin JJ, Marks HG. Efficacy and tolerability of topiramate in pediatric migraine. Pediatr Neurol. 2009 Sep;41(3):167-70.

Goraya JS, Cruz M, Valencia I, Kaleyias J, Khurana DS, Hardison HH, Marks H, Legido A, Kothare SV. Sleep study abnormalities in children with attention deficit hyperactivity disorder. Pediatr Neurol. 2009 Jan;40(1):42-6.

Kaleyias J, Cruz M, Goraya JS, Valencia I, Khurana DS, Legido A, Kothare SV.
Spectrum of polysomnographic abnormalities in children with epilepsy.
Pediatr Neurol. 2008 Sep;39(3):170-6.

Goraya JS, Khurana DS, Valencia I, Melvin JJ, Cruz M, Legido A, Kothare SV.
Intravenous levetiracetam in children with epilepsy.
Pediatr Neurol. 2008 Mar;38(3):177-80.

Vendrame M, Khurana DS, Cruz M, Melvin J, Valencia I, Legido A, Kothare SV.
Aggravation of seizures and/or EEG features in children treated with oxcarbazepine monotherapy. Epilepsia. 2007 Nov;48(11):2116-20.

Goraya J, Marks H, Khurana D, Legido A, Melvin J.
Subacute sclerosing panencephalitis (SSPE) presenting as acute disseminated encephalomyelitis in a child. J Child Neurol. 2009 Jul;24(7):899-903

Faculty and Clinical Interests

Agustin Legido, MD, Section Chief: Epilepsy, HIV, neonatal neurology, mitochondrial disorders

Karen Carvalho, MD: Epilepsy, EEG, sleep

Mitzie Grant, PhD: Neuropsychologist

Michael Goldenthal, PhD: Mitochondrial laboratory

H. Huntley Hardison, MD: Neurobehavioral, Autism, ADHD, development

Reena Jethva, MD: Metabolic diseases and Clinical Genetics

Christos Katsetos, MD, PhD, MRC Path: Neuropathologist, Pediatric neuropathology, developmental neuropathology, brain tumors

Divya Khurana, MD: Epilepsy, EEG, sleep

Harold Marks, MD: Metabolic, neuromuscular

Ignacio Valencia, MD (Program Director): Epilepsy, EEG, sleep

Current Fellows

Dr. William Yorns, 2012 class
Dr. Indira Kumar, 2013 class
Dr. Diana Walleigh, 2014 class
Dr. Chandrabhaga Miskin, 2015 class

Application Procedures

The applicant needs to apply through the ERAS and the National Resident Matching Program for a five-year combined program that includes two years of preliminary Pediatrics and 3 years of Child Neurology (one year of adult and two years of Child Neurolody). USMLE step 1 or equivalent is required for the application. USMLE step 2 results are required before rank list is submitted. Passing USMLE step 3 is required before finishing the years of General Pediatrics.

Contact Information

Program Coordinator: Jessica Lilly: Jessica.lilly@tenethealth.com
Program Director: Ignacio Valencia, MD: ignacio.valencia@drexelmed.edu
Section of Pediatric Neurology
St. Christopher’s Hospital for Children
3601 A Street
Philadelphia, Pa. 19134
(215) 427-8372