We are also involved in education for residents in pediatric, adult neurology and rehabilitation.

The division provides neurological care at the Children’s Hospital of Eastern Ontario (CHEO) for children across Eastern Ontario, Western Quebec, parts of Northern Ontario and Nunavut. We have six full-time and two part-time neurologists who undertake approximately 4,000 patient visits per year. Specialized clinics provide treatment in epilepsy, sleep, white matter disorders, movement disorders, neuromuscular disorders, Tourette syndrome and Rett syndrome.

We are active members of many research networks nationally and internationally and strive to bring evidence-based care to all of our patients.

Related links

• Canadian Bioethics Society
• Canadian Paediatric Society
• Canadian Tri-council core skills tutorial for research ethics

The Division of Neurology at CHEO provides inpatient and outpatient consultation services to children with complex neurological disorders. State-of-the-art diagnostic measures and management are provided for patients presenting with developmental delay, epilepsy, movement disorders, cerebral palsy, neuromuscular diseases, stroke, demyelinating disorders, neurogenetic and neurometabolic disorders and fetal neurology.

Inpatient care (439 consults/admissions in 2013)

Patients are seen with a variety of neurological presentations. The major inpatient activity for the Neurology team is the neurological assessment of referred patients.

Patients are predominantly seen for:

• Complex Epilepsy
• Ketogenic Diet Clinic for Intractable Epilepsy
• Epilepsy Monitoring Unit (EMU)

Outpatient care (4678 patient visits in 2013)

While outpatients are seen in a number of neurology clinics with a variety of neurological presentations, the major outpatient activity for the Neurology team is to see patients with the following disorders:

Patients are predominantly seen for:

• Movement Disorders
• Rett Syndrome
• Neuromuscular Disorders
• Complex Epilepsy
• Ketogenic Diet Clinic for Intractable Epilepsy
• Multiple Sclerosis (MS) and Inflammatory Brain Disorder
• Tics / Tourette Syndrome 

Clinical problems and diseases evaluated and followed

• Movement disorders
• Rett syndrome
• Neuromuscular disorders
• Complex epilepsy
• Ketogenic diet clinic for intractable epilepsy
• Multiple Sclerosis (MS) and Inflammatory Brain Disorder
• Tics/Tourette syndrome
• Complex Epilepsy
• Epilepsy Monitoring Unit (EMU)

Neurophysiology

Electromyography (EMG) and nerve conduction

This clinic evaluates children and young adults suspected of having a nerve or muscle disorder. This can include acquired causes such as a traumatic injury or a possible hereditary cause. Our clinic performs several diagnostic tests depending on the individual’s clinical symptoms. These tests include: nerve conduction studies, repetitive nerve stimulation studies, EMG, single-fibre EMG and stimulated single fibre EMG. 

Electroencephalography (EEG)

The neurophysiology laboratory performs routine EEGs as well as prolonged outpatient EEGs. We are also developing an Epilepsy Monitoring Unit (EMU) which will consist of inpatient beds dedicated to the monitoring of patients with epilepsy and suspected epilepsy, using simultaneous recording of video and EEG over extended periods of time. The unit will include a multi-disciplinary team of epileptologist, EEG technologist, nurses, neuropsychologist and medical social worker.  

Evoked potentials (EPs)

Evoked potentials include pattern reversal visual evoked potentials (VEPs), short latency somatosensory evoked potentials (SSEPs) and brainstem auditory evoked potentials (BAEPs).

The clinical value of evoked potentials (EPs) is based on their ability to:

• Demonstrate abnormal sensory system conduction, when the history and/or neurological examination is equivocal
• Reveal subclinical involvement of a sensory system (‘‘silent’’ lesions)
• Identify demyelination which is suggested by symptoms and/or signs in another area of the central nervous system
• Help define the anatomic distribution and give some insight into pathophysiology of a disease process
• Monitor changes in a patient’s neurological status

Specific areas of research include, but are not limited to:

• Multiple Sclerosis (MS)
• Rett syndrome
• Headaches
• Neuromuscular disease
• Epilepsy
• Medical education 

The division also participates in a large number of international, multi-centre studies focusing on:

• Novel treatments for epilepsy
• Quality of life in epilepsy
• The causes and treatment of pediatric stroke
• Pediatric demyelinating disease and MS
• Therapy in Duchenne muscular dystrophy
• Outcome of Guillain-Barre syndrome

Undergraduate training opportunities

Undergraduate education in the Division of Neurology includes the following:

• Case based learning (CBL) teaching during Unit III for neurology relevant topics
• During unit III, lectures are provided on:
  • Nervous system developmental pathology
  • Neurophysiology
  • Neurological examination in pediatric neurology
• Lectures on Tourette syndrome and attention deficit hyperactivity disorder (ADHD) during the integration block when medical students are in their last year preparing for clerkship
• Several staff participate every year in the Objective Structured Clinical Examination (OSCE) during the pediatric clerkship
• Monthly neurology PALs sessions for undergraduate students doing general pediatric rotation
• Visiting medical students doing elective rotations are taught at beside and present every week at the localization rounds. Electives vary from one to two weeks and can occur at any level of training
• Undergraduate students also work with different staff during the summer for research or scholarly relevant projects
• PSD teaching during pediatrics block, where students attend clinics and are taught basic examination skills used in pediatrics and pediatric neurology 

We actively participate in several other student/mentor programs including: 

• ePortfolio - every year, four groups are coached in this program which is intended to develop and evaluate the “hidden curriculum”
• Mentorship program - several times a year division staff mentor a group of medical students from all years of study to develop a liaison between staff and students as well as among the students for their academic and social growth

Postgraduate training program

The University of Ottawa and the Children’s Hospital of Eastern Ontario (CHEO) offer a pediatric neurology residency training program that is fully accredited with the Royal College of Physicians of Canada.

Our program offers one residency training position each year for Canadian medical school graduates (CMG) through the Canadian Residency Matching Service (CaRMS). Our program also offers one training position for international medical school graduates (IMG) every several years. The pediatric neurology residency program is five years in duration.

The Division of Neurology also offers a one-year pediatric clinical epilepsy fellowship to develop knowledge and proficiency in electroencephalography as well as in clinical epilepsy. At the end of the year, the trainee should be eligible for the Canadian Board of Clinical Neurophysiology (EEG) examination conducted by the Canadian Society of Clinical Neurophysiologists. As well, the trainee should be eligible to sit the Royal College of Physicians and Surgeons of Canada examination in Neurology or equivalent training/qualification.

Interested candidates should contact Dr. Katherine Muir, program director of the Pediatric Neurology Residency Program.

Additional postgraduate training

Residents will be exposed to a full range of neurological diseases affecting infants, children and adolescents. Our six full-time and two part-time pediatric neurologists possess subspecialty fellowship training and/or additional expertise in:epilepsy/EEG, neuromuscular/EMG, demyelinating diseases, neuro-oncology, sleep neurology, neurodevelopmental disorders, movement disorders, stroke and headache. Other pediatric subspecialists at our site offer additional expertise in neuroradiology, neurosurgery, neurogenetics, metabolics, ophthalmology, physical medicine and rehabilitation, neuropsychology and palliative care.

Our residency program has very strong links with the adult neurology residency training program at The Ottawa Hospital Civic and General campuses, The Ottawa Eye Institute (neuro-ophthalmology), as well as the Ottawa Children’s Treatment Centre (OCTC) (developmental pediatrics). Our centre also offers residents the unique opportunity to participate in subspecialty clinics in Nunavut (Qikiqtani General Hospital) and care for patients in the Rett syndrome clinic. Residents will have the opportunity to complete community neurology rotations if interested.