U of T Crest Faculty of Medicine / University of Toronto
Department of Paediatrics
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 > Department of Paediatrics > Divisions > Neurology

Neurology



Dr. Steven Miller - Division Head

In addition to general Neurology, the focus of our clinical activities are: the medical and surgical management of refractory paediatric epilepsy; the diagnosis and management of paediatric neuromuscular and neurometabolic disease, Multiple Sclerosis in children, paediatric stroke, paediatric headache, and medically complex disabilities including autism. The division provides an approved specialty program in Child Neurology, both three- and five-year programs (Royal College of Physicians and Surgeons of Canada Accredited). In addition, the division has an approved program in clinical neurophysiology training and subspecialty training programs in Paediatric Epilepsy and Paediatric Stroke. The major foci of our research activities fall into the following areas:


  • Molecular and Cellular Neurobiology;
  • Epilepsy;
  • Stroke;
  • Learning Disabilities;
  • Attention Deficit Disorder Hyperactivity;
  • Autism;
  • Neuroimaging;
  • Fatty Acid Oxidation Disorders.
Education

The Paediatric Neurology Residency and Fellowship Training Program at The Hospital For Sick Children (SickKids), University of Toronto
is a fully accredited program with the Royal College of Physicians and Surgeons of Canada. To date, training is also recognized by the American Board of Neurology and Psychiatry for training in Child Neurology.

There are two training tracks - a three-year program with the entrance requirements being two or three years of accredited paediatrics training or a five-year training program with entrance directly from medical school.

There is a Paediatric Neurology Training Committee responsible for supervision of all educational and training activities. The committee meets monthly throughout the academic year and is responsible for resident and fellow selection with the final deadline for the following academic year being September 30. Candidates however are encouraged to approach the Training Director, Dr. Teesta Soman, well before this deadline such that interviews can be arranged. The most preferred point would be approximately 18 months prior to the requested onset of training. Highly qualified candidates will be judged for appointments based on review of curriculum vitae, personal letter with comment on career goals and plans, review of letters from referees and interviews. The five-year training program is accessed through CaRMS (Canadian Resident Matching Service).

The program is committed to excellence in training individuals for careers in academic and research-based child neurology. The hospital is enriched by an association with the Hospital For Sick Children Research Institute and activities with the basic neuroscientists include regular combined rounds and seminars. There is also activity with the other clinical neurology groups at the hospital including the neurosurgeons and neuroradiologists with weekly rounds.

Residents are responsible for a research project in each of their training years and there is a research day held in February of each academic year. Residents are encouraged to attend scientific meetings, including the Canadian Congress of Neurological Sciences, the Child Neurology Society and the
American Academy
of Neurology. Funding is available to assist with travel. Residents are also encouraged throughout their training to begin to learn the process of writing research grants and there is assistance for this activity through the Research Institute. Small amounts of money can be made available through the hospital for pilot project funding.

For further information regarding the Neurology training programs, contact us at
neurology.training@sickkids.ca.

The three-year program (begun after completion of two or three years of appropriate paediatric training) meets the Royal College of Physicians and Surgeons of Canada requirements for training in Neurology with special competence in Child Neurology. The full details of the necessary elements are found in the Royal Collegetraining booklet. The basic training consists of 18 months of General Paediatric Neurology and six months of Adult Neurology. The remaining period of time can involve varying periods of specific training in the neurology subspecialties or elective work as determined by discussions with the program director.

At SickKids, there are three months of block rotations in general and subspecialty activities. The general neurology block specifically consists of time on the inpatient neurology service with cross responsibilities for emergency room coverage. There is a second inpatient team which is responsible for the consultation service. The various subspecialty rotations consist of activities in epilepsy, neurorehabilitation/neurodevelopment, neuromuscular and neurometabolic disease and ambulatory/community neurology. There are elective and selective periods offered in Neuroradiology, Neuropathology, Neurosurgery and Psychiatry. SickKids has an excellent Clinical Genetics and Metabolics Division - residents are encouraged to seek an elective with this group.

The five-year training program is begun after medical school and the full description of this program is found in the CaRMS booklet. There are two core training years in Paediatrics and Adult Neurology with three months of Neuropathology. There are then three years of general child neurology training which includes the possibility of a full research elective year. The rotations offered are similar to those in the three-year program and are of three-month block format.

Epilepsy Fellowship: One- and two-year epilepsy fellowships are offered which are funded through the Division of Neurology. The first year of the fellowship focuses on EEG reading, evaluating and following children with seizure disorders in i) an ambulatory setting, and ii) the Epilepsy Monitoring Unit. In addition, fellows assess and follow children who are undergoing evaluation for epilepsy surgery. Fellows are also required to participate in clinical and teaching conferences as well as a journal club

The second year focuses on EEG-video interpretation, evoked potentials, epilepsy surgery and participation in clinical and teaching conferences and in the journal club. A research project, either basic or clinically-based is mandatory for completion of the two-year fellowship.

The division offers state-of-the-art clinical neurophysiology facilities, ambulatory clinics in paediatric epilepsy, an epilepsy surgery program (intraoperative ECoG), invasive monitoring (subdural grids and depth electrodes), neuroimaging (fMRI, MEG, MSI), an epilepsy classroom and an epilepsy research program.

Laboratory-based and clinical research opportunities are available. Interests range from molecular and cellular basis of epileptogenesis to development of animal models of epilepsy, to clinical trials of new antiepileptic drugs, to neuroimaging and neuropsychological studies of epilepsy in children.

Prerequisite: Completion of training in Neurology or Paediatric Neurology.

If interested, apply to:
neurology.training@sickkids.ca

Stroke Fellowship: This is a two-year fellowship. Interested applicants should have completed or be completing their paediatric neurology, paediatric hematology or adult neurology training and have a strong interest in a clinical research career specializing in childhood stroke.

Training in a MSc in Epidemiology at the
University of Toronto or McMaster University
would be supported, and since the clinical service involves one outpatient clinic and three to four ward consultations per week, there is ample time for course work and research projects. The stroke service is supported by one full-time stroke nurse practitioner. Experience in paediatric thrombosis is available as part of this fellowship.

The paediatric stroke fellowship was started in July 1999 and has well-developed objectives, weekly teaching sessions and provides excellent research and clinical training, career mentorship and interface with the Neurology Fellows at SickKids. For further information contact:
gabrielle.deveber@sickkids.ca

History

The first neurological consultant at SickKids was appointed in 1912. In the ensuing five decades, responsibilities falling under the umbrella of neurology included not only neurology itself but psychology, social work, psychiatry, and speech pathology. Dr William Hawke was the director of this diverse group of staff.

In 1965, a review by the Royal College of Physicians and Surgeons led to the formation of separate divisions for neurology and psychiatry. Dr. John Stobo Prichard, who had joined the neurology staff in 1951 to establish an electroencephalography (EEG) laboratory, was appointed head of the new Division of Neurology. During his 13-year tenure as Division Head, Dr. Prichard made lasting contributions to paediatric neurology, particularly in the study and treatment of epilepsy in children. He also established the Child Development Clinic, and served as an advisor to the Ontario government.

During the 1980s and early 1990s, significant divisional activities included the appointment of a Director of EEG and Special Procedures, the creation of a laboratory dedicated to the study of neurophysiology, and the establishment of an epilepsy monitoring unit. A unique neurological specialty neurometabolic studies also emerged during this time.

The division's activities shifted focus in the 1990s, with expansion of the ambulatory clinics and the use of daycare facilities for neurological investigations. The Child Development Clinic (renamed Centre after the clinic was moved to new facilities) has turned its attention to developmental disorders in children with chronic health problems, and is doing original research on autism. At the end of February 2005, the Child Development Centre moved from SickKids to the Bloorview MacMillan Children's Centre in response to recent major advances in the area of developmental paediatrics. SickKids and Bloorview MacMillan Children's Centre have created an enhanced child development program which provides a single access point and triage system for families, consolidating resources, with a goal of seeing more children sooner.

The Epilepsy Surgery Group which also includes neurosurgeons, neuroradiologists and neuropsychologists has developed an excellence in the treatment of children with intractable seizure disorders supported by new technology including complex MRI studies and MEG. The work of the division is subspecialized offering treatment to children with tertiary-level neurological problems in the following ambulatory clinics: Neurodevelopment, Epilepsy, Movement Disorders, Headache, Stroke, Neuromuscular Disorders, MS/Demyelinating Diseases and Neurometabolic Disorders.

With the development of the Paediatric network, the division trained community-based child neurologists located in many of the network hospitals to provide neurological care at the primary and secondary level. These physicians integrate academically with the SickKids group--attending Neurology Grand Rounds via the TeleHealth system. Continuing links with the Bloorview MacMillan Childrens' Centre and Surrey Place Centre provide neurological care for children with developmental disorders and rehabilitation needs.


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