About the Neuroscience Center of Excellence
The ACH Neuroscience Center of Excellence provides a comprehensive, coordinated center to treat brain, nervous system and neuromuscular disorders. It is the only program in Arkansas devoted to pediatric neurology and neurosurgery. What makes the Neuroscience Center so effective for patients is that it serves as a one-stop facility where patients can see all subspecialists in a convenient setting. Subspecialists may include neurologists, neurosurgeons, neurooncologists, neuropsychologists, geneticists, speech pathologists, child life specialists, social workers, rehabilitation specialists, anesthesiologists and specialty nurses.
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Problems Diagnosed and Treated
Brain tumors
Pediatric neurosurgery needs
Craniofacial disorders
Headache (migraine, tension, sinus infection, and other serious headaches)
Head injuries
Muscular dystrophy
Spina Bifida
Pediatric neurology, epilepsy and neurophysiology needs
Some of our current treatments for epilepsy include:
- Ketogenic Diet is essentially a diet high in fat and low in carbohydrates yet provides enough protein for growth. While most children with seizures are treated with medicine, in some cases the medicine doesn’t stop the seizures or produces an unwanted side effect. The ketogenic diet can be used to treat seizures, and research has indicated large levels of ketones can help reduce some childhood seizures such as myoclonic, absence and generalized tonic-clonic or grand mal seizures, as well as the type of seizures associated with Lennox-Gastaut Syndrome. A clinical nutritionist and neurologist coordinate the diet.
- Vagus Nerve Stimulation involves the Vagus Nerve Stimulator, approved by the U.S. Food and Drug Administration in 1997. It is another treatment for seizures, and ACH has surgically placed the devices (about the size of a pacemaker) regularly since their approval. The stimulator is a device that is placed under the left side of the chest. It has soft, flexible wires, or leads, that travel under the skin and up the neck, wrapping around the vagus nerve in the neck. This nerve carries information to the brain, and the device emits a mild, brief current or stimulation to the vagus nerve within a regular interval. The recipient of the stimulator can carry a special magnet to trigger extra stimulation to stop or lessen a seizure.
Spasticity and movement disabilities
Some of our current treatments for spasticity include:
- Intrathecal Baclofen Therapy (IBT) is an option for treating spasticity caused by cerebral palsy and/or brain injuries. "Intrathecal" refers to the space along the spinal cord where cerebral spinal fluid (CSF) flows. This is where the medicine, baclofen, is delivered. CSF is a clear fluid produced within the ventricles, or spaces, of the brain. CSF circles around the brain and spinal cord and acts as a shock absorber to protect delicate structures. The liquid baclofen mixes with the CSF and is absorbed into the spinal tissue and works directly in the spine to reduce spasticity. The baclofen is constantly delivered along the spinal cord by a surgically implantable, battery-operated drug pump system consisting of a pump and a catheter.
- Botulinum Toxin Type A (Botox) is a toxin that can block the message sent from the nerve to the muscle. It causes paralysis in the muscles where the Botox shot is given, with effects lasting approximately three months. The paralyzed effect on the muscle that receives the Botox helps reduce extra and abnormal contractions that cause the muscle to be tight.
- Rehabilitation Therapy, such as physical therapy (PT), occupational therapy (OT), casts, braces and splints, is very useful in neurological cases. Casts, braces and splints can help reduce spasticity and stretch contracted or shortened muscles. The goals of PT and OT include maintaining or improving joint range and muscle strength; reducing or relieving pain and swelling; relieving muscle spasms; preventing problems related to inactivity; teaching proper usage of adaptive equipment; and teaching self care and walking techniques.
- Oral Medications primarily include Baclofen (Lioresal), Diazepam (Valium), Dantrolene (Dantrium) and Tizanidine (Zanaflex).
- Rhizotomy (selective dorsal or posterior) is an operation performed by a neurosurgeon and is used to treat children with spastic Cerebral Palsy. The surgery exposes the lumbar nerves in the spinal canal that go to and from the muscles in the legs. The nerves are divided into many branches with each one stimulated. The procedure cuts stimulation to 30 percent to 50 percent of the top half of each nerve that gives an abnormal response. Rhizotomies can permanently relieve spasticity in legs, and therapy can improve walking.
- Orthopedic Surgery corrects the muscle and bone defects caused by spasticity, but it does not modify the spasticity itself. There are three common procedures: tendon lengthening, tendon transfer and osteotomy.
Our Inpatient Services, In Summary
The 12-bed Neuroscience Unit at Arkansas Children’s Hospital is the only program in Arkansas devoted to pediatric neurology and neurosurgery. It offers patients a comprehensive and coordinated center for the treatment of brain, nervous system and neuromuscular disorders. The Unit has 24-hour epilepsy monitoring beds as well as a video EEG technician. Within this unit, physicians, nurses and other professionals who specialize in neurological and neurosurgical disorders evaluate, treat and follow patients. This team approach offers the most comprehensive care possible.
The Neurosurgery service at Arkansas Children's Hospital provides
comprehensive diagnosis and treatment for patients with congenital and
acquired illness/injury. Children with the following disease processes and
injuries are cared for on the Neuroscience Unit:
- Tumors of the brain and spinal cord
- Surgical intervention for seizure disorders no longer controlled by
medication and/or diet
- Hydrocephalus (water on the brain) requiring surgical placement and management of a shunt to assist with drainage of excess fluid from the brain
- Children with multiple trauma involving the brain and/or spinal cord
- Treatment and management of congenital conditions involving the brain and
spinal cord, such as tethered cord, spina bifida, myelomeningocele, etc.
Our Outpatient Services, In Summary
The center offers neurological treatment with a multidisciplinary team approach that includes physicians, nurses and other neurological and neurosurgical specialists through 10 established clinics and a Laboratory. All services are available to your child by physician referral. Talk with your child’s physician and tell him/her you would like to be referred to ACH. Have the doctor contact the Arkansas Children’s Hospital Physician Services Department to make a referral. If your child does not have a regular physician, please call 501-364-5901 and we will be happy to recommend one in your area.
- Arkansas Pediatric Neurooncology Clinic (APNOC) or Brain Tumor Clinic
The Brain Tumor Clinic is staffed by a team that includes a pediatric neurosurgeon, a surgical neurooncologist, a pediatric neurologist, a pediatric oncologist and a pediatric neuropsychologist. A social worker and a financial counselor offer support services for patients and families. These staff members work to provide state-of-the-art care for patients by delivering multidisciplined care for children with brain and spinal cord tumors. The clinic provides the most progressive techniques to skull base tumors, endoscopic third ventriculostomy for definitive treatment of hydrocephalus secondary to posterior fossa tumors, registration in Pediatric Oncology protocols, SPECT, MRI, MRA and interventional neuroradiology.
- Craniofacial Clinic
The Craniofacial Clinic is the only program of its kind in the region and focuses on plastic surgery, pediatric neurosurgery, dentistry, psychology, speech pathology genetics and social work. The team includes a craniofacial plastic surgeon, a craniofacial orthodontist, a geneticist and a nurse practitioner. The team also incorporates the expertise of pediatric neurosurgeons, an otolaryngologist, a prosthetist, an orthotist, a speech/language pathologist and a child life specialist. The team has extensive training and expertise in the treatment of craniofacial malformations and disorders and practices state-of-the-art surgical procedures. Team members combine efforts to provide outstanding evaluation and surgical management. The group is often recruited for national referrals.
- Headache Clinic
The Headache Clinic evaluates and treats children with headache disorders. Childhood headaches, including migraines, are actually very common and can occur frequently, causing school absenteeism. Types of headaches treated include migraine, tension, sinus infection and other more serious headaches.
The team at ACH includes a psychologist, physical therapist and social worker. Neurologists provide consultative services. Therapeutic approaches include medication management, relaxation/biofeedback, and physical therapies.
- Head Injury Clinic
The Head Injury Clinic is designed to help the child and family with the long-term effects of post-traumatic complications from head injuries. Most patients come to the clinic following inpatient rehabilitation on the Progressive Rehabilitation Unit of the hospital, but referrals are accepted. The team includes a patient care coordinator, a specialty nurse, the clinic manager, a social worker, a speech and language therapist and a neuropsychologist. The clinic addresses medical and psychological concerns, including diagnosis of any late medical or neurological complications and interventions. This includes medication management as indicated, neuropsychology referrals, ongoing assistance with home, educational and community re-entry, and screening and follow up of dysphagia and cognitive or higher level language issues with speech and language pathology.
- Muscular Dystrophy and Neuromuscular Clinics
These clinics provide management and ongoing evaluation of children with muscular dystrophy, peripheral neuropathies, metabolic and structural myopathies, brachial plexus disorders and other rare muscle and nerve disorders. The clinic is staffed by a pediatric neurologist with specialized training and expertise in the diagnostic evaluation and treatment of children with neuromuscular disorders and pediatric rehabilitation specialist. Diagnostic studies include electromyography (EMG), muscle strength testing, muscle biopsies and muscle pathology evaluation. Pediatric rehabilitation physicians provide evaluation for physical therapy and other interventional treatment, orthotic services and rehabilitation management, and the clinic can provide genetic testing and counseling. Children who develop associated respiratory insufficiency and complications undergo pulmonary management by pediatric pulmonologists. The clinic provides a Muscular Dystrophy Association patient representative, who is available with information for families on various conditions and MDA services, such as summer camp. The clinic offers a proactive program of pulmonary assessment and care and also refers patients for cardiology studies and consultation.
- Pediatric Neurology and Epilepsy Clinic
This clinic diagnoses and treats disorders associated with the peripheral and central nervous systems, and it provides care for children with epilepsy or seizures. The neurology portion of the clinic is staffed by pediatric neurologists and nurses who provide diagnostic and therapeutic services for children with neurological disorders. The clinic also performs evaluations on patients who are not identified for one of the multispecialty clinics or do not require more comprehensive evaluations or ongoing care. The epilepsy area of the clinic chiefly serves children with epilepsy or seizures, with these patients undergoing comprehensive evaluations. Children with associated learning disabilities and problems are evaluated by a pediatric neuropsychologist, and the clinic uses appropriate intervention programs to promote success in educational and vocational endeavors. The clinic is staffed by pediatric neurologists, all experienced in epilepsy and electroencephalograph (EEG). Specialty nurses are also available to provide patient education.
- Neurophysiology Laboratory
A component of the Pediatric Neurology and Epilepsy Clinic is the on-site Neurophysiology Laboratory, which provides state-of-the-art neurophysiological testing for inpatients and outpatients of all ages. The lab provides routine and portable EEG, digital EEG, evoked potential, EMG, intraoperative monitoring for neurosurgery and orthopedic surgery and extensive, long-term video telemetry EEG for both medical and surgical treatment of epilepsy. The lab conducts other neurophysiological studies, among them investigational antiepileptic drug studies with clinical trials for new medications for treating medical intractable seizures and an active epilepsy surgery program for treating patients with medically intractable seizures. Testing must be scheduled through a physician.
- Epilepsy Monitoring Unit
A primary component of the Neurophysiology Lab is the Epilepsy Monitoring Unit. The four-bed unit has state-of-the-art computerized EE input and can provide continuous 24-hour video EEG monitoring used to characterize and diagnose epileptic seizures and related disorders. Two key seizure treatments available through the unit for patients with difficult-to-control seizures are a well-established ketogenic diet program and a vagus nerve stimulator program.
- Pediatric Neurosurgery Clinic
The Pediatric Neurosurgery Clinic is operated by a neurosurgeon with specialized training and extensive expertise in the evaluation and treatment of neurosurgical conditions in children. The clinic provides management and ongoing evaluation of children with tumors, spina bifida, hydrocephalus, epilepsy, craniofacial disorders, spinal cord injury, head injury, spasticity, brachial plexus disorders, Arnold Chiari Malformation and genetic disorders of the nervous system.
- Pediatric Pain Management Clinic
The Pediatric Pain Management Clinic/Program provides interdisciplinary treatment for infants, children and adolescents with acute and chronic pain. The patients with acute pain include postoperative patients, trauma patients and patients with exceptional pain problems. The treatment for these patients includes patient controlled analgesia and epidural infusions. The goal of acute pain management is to control the level of pain in a safe manner and enhance the recovery process. The chronic pain team is interdisciplinary, consisting of personnel from psychology, physical therapy, child life, social work and psychiatry. These patients are preferably seen on an outpatient basis.
- Spasticity and Movement Disability Clinic
The Spasticity and Movement Disability Clinic provides management and ongoing evaluations of children with spasticity and movement disabilities. The clinic, directed by rehabilitation specialists, offers diagnostic, therapeutic and rehabilitation services for children with cerebral palsy. Pediatric neurologists take an active role in managing seizures and related problems. Pediatric neuropsychologists perform some assessments. Subsets evaluate children with spasticity, chorea, athetosis and other associated movement disorders that require surgical treatment. The clinic offers innovative therapy for cerebral palsy and spasticity with an Intrathecal Baclofen pump and Botulinum toxin (Botox) injections. Traditional modalities include rehabilitation therapy, oral medications and surgical intervention.
- Spina Bifida Clinic
This clinic provides multifaceted care to children with neural tube defects
and associated disorders as well as patients with childhood acquired spinal
cord injury or anomalies. These patients typically have multisystem complications
and require care from several specialists. Orthopedists and urologists manage
associated bone and genitourinary complications. Rehabilitation specialists
oversee the ongoing therapy and orthotics, and specialty nurses and other
staff provide additional support. Services provided at the clinic include
neurosurgery, orthopedics, pediatric rehab, urology, physical therapy, occupational
therapy, orthotics, nutrition and social services. The Spina Bifida clinic
makes referrals to clinics such as genetics, neuro-ophthalmology, gynecology,
urodynamics, dentistry, ENT, psychology and psychiatry. The clinic specializes
in evaluation and management.
The Bottom Line….Why You Should Choose Our Hospital
Care for children is different than care for adults. We know that at Arkansas
Children’s Hospital. For more than years, we have dedicated ourselves
to bringing the latest pediatric medical expertise and technology to the children
of all ages. We provide services not usually found at other hospitals: pediatric-trained
anesthesiologists, radiologists, nutritionists, pain managers, respiratory
therapists, nurses, etc. We even have Child Life and Education staff here
to explain procedures to children and to incorporate play and schoolwork into
the hospital stay where appropriate. Best of all, we center our care around
the family. Your team of physicians, nurses, and other staff will work tirelessly
to make sure your entire family has the resources it needs to better your
child’s health. We are dedicated to changing children’s lives!
How to Contact Us
You can reach members of the Neuroscience Team by calling 501-364-1850.
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