Rotation Contact:

Rotation Director – Robert Greenwood, MD (greenwor@neurology.unc.edu)

First Day Information:

Page Stephanie Wolfe (Chief Resident) at 8:00am on the first day.

Goals and Objectives:

OVERALL EDUCATIONAL GOAL:

To achieve competency in General Pediatrics, the resident completing the elective in Child Neurology should be able to (1) perform a neurological examination in infants and children of different ages, (2) recognize neurological conditions commonly encountered by a practicing pediatrician, (3) become competent in diagnosing and managing pediatric neurology conditions that they may encounter in practice, (4) recognize severe or life-threatening neurological conditions, and (5) become familiar with diagnostic tests and procedures used in Child Neurology.

OBJECTIVES:

On completion of the elective, the resident should be able to:

Perform a complete neurologic examination on children of different ages. (PC)

The faculty in the Child Neurology clinic will assess the resident’s skills in performing a neurologic examination.

At the start of the rotation the resident should go to Pediatric NeuroLogic Examination Videos and Descriptions: A Neurodevelopmental Approach at http://Library.med.utah.edu/pedine. Residents will need to learn how to take a neurological history and how to screen for neurological problems and identify components of the neurologic examination that need to be done in detail as identified by a particular chief complaint and history.

Evaluate the patient with developmental delay. (PC, MK)

Recognize and evaluate global developmental delay, cerebral palsy, autistic spectrum disorder, and neuromuscular disorder.

Distinguish static encephalopathy from a progressive encephalopathy.

Define and describe the various subtypes of cerebral palsy.

Learn about the usefulness and extent of diagnostic evaluation needed for patients with developmental disorders, how to enlist the help of other specialists, and how to identify resources for treatment and community management.

Identify and diagnose autistic spectrum disorders from a Child Neurology perspective. (PC, MK)

Identify the characteristic features of childhood migraine. (PC, MK)

Identify features of headaches in children that suggest raised intracranial pressure or mass lesions.

Begin to manage headaches with both symptomatic and preventative migraine therapy.

Recognize, evaluate, and manage febrile seizures. (MK, PC)

Distinguish between simple and complex febrile seizures.

Become familiar with the epidemiology, etiology and management of febrile seizures.

Identify various seizure types based on ILAE classification. (MK, PC)

Distinguish between focal and generalized seizures, and symptomatic seizures versus epileptic seizures.

Learn the use of EEG and neuroimaging in the evaluation and diagnosis of seizures.

Begin to understand and manage seizures including anticonvulsant drug choice, dosing, and side effects and alternative measures for treating epilepsy, ketogenic diet, vagal nerve stimulator and epilepsy surgery.

Learn the diagnostic criteria for ADHD and various co-morbid conditions. (MK, PC)

EVALUATION:

Resident

Resident performance is observed daily by an Attending. The pediatric residents will be provided with continuing feedback during the rotation.

At the conclusion of the elective, the Attending will complete an evaluation form indicating their estimation of the degree to which the Resident has successfully achieved each of the objectives of the elective.

Elective

The Resident evaluates (1) the effectiveness of the elective experience in providing adequate information and instruction to facilitate achieving each objective, and (2) the performance of each Attending as a teacher.

LEARNING ACTIVITIES OF THE ROTATION:

Clinic

The resident will see patients with all of the Child Neurology attendings over the course of their rotation. The resident will not have his/her own patient schedule. Rather, he/she will see the attending neurologists’ patients. The resident is expected to see both new and follow-up patients.

The resident should obtain a history, perform a physical examination, formulate a plan, and then present his/her findings and plan to the attending. The attending will review the plan and then see the patient in conjunction with the resident.

Residents are encouraged to attend clinic with as many different faculty as possible to achieve a wide range of teaching perspectives. A list of each faculty’s weekly clinic schedule will be provided to the residents at the onset of the Child Neurology elective.

Teaching/Conferences

The outpatient resident is expected to attend the Child Neurology Clinical Case Conference on Wednesday mornings. The residents will also be encouraged to attend any of several teaching conferences given during the elective including, but not limited to Neurology Grand Rounds, neurology subspecialty and procedure-related conferences in addition to the required pediatric residency conferences.

Readings and Resources

Clinical Pediatric Neurology: A Signs and Symptoms Approach: Expert Consult Gerald Fenichel. A copy can be found in the Child Neurology Clinic

Washington University Neuromuscular Website

OMIM and Genetests

Other references material in the Child Neurology Clinic