Neurology - Paediatric Neurology
The department is based in the Littlewoods Neurosciences Unit at Alder Hey. The unit opened in 2005, thanks to a generous donation from the Littlewoods Group. The unit consists of a 14 bed Paediatric Neuromedical ward, outpatient facilities and Neurophysiology service.
The ward admits children requiring inpatient neurorehabilitation with integrated facilities including therapy rooms and a specialist rehabilitation classroom.
The 16 bed neurosurgical ward (including 5 Neurosurgical HDU beds) is located immediately above the paediatric neurology ward. The neurology and neurosurgery consultant offices are co-located within the unit, enhancing collaborative working between the departments – a particular strength at Alder Hey. The Neurosciences Unit is adjacent to the PICU.
The neurophysiology department is integrated into the Neurosciences Unit with onsite videotelemetry, EMG, invasive EEG and expertise in performing respiratory and neurological sleep studies.
The neurology unit has close links with the Department of Community Child Health which provides community neurodisability services, Child Mental Health Services also provided by the Trust, Clinical Genetics (based at Liverpool Women’s Hospital) and also with the Walton Neurosciences Trust, the adult-based neurological centre located just four miles from Alder Hey. There is also close working with the radiology department with access to advanced neuroimaging techniques including a 1.5T and 3T intraoperative MRI scanner, SPECT and angiography. There are weekly neuro-radiology meetings.
Much of the work undertaken by the neurology department involves children outside Liverpool, including Merseyside, Cheshire, North Wales, the Isle of Man and parts of Lancashire and Shropshire as well as elsewhere in the UK. The five consultant neurologists undertake over 60 peripatetic outreach clinics in 13 separate hospitals and child development centres, in both general and specialist paediatric neurology in conjunction with the local general and community paediatricians.
The paediatric neurology department is spearheading the development of tele-medicine clinics with these partner sites across the North West.
About the Consultant Paediatric Neurologists
The paediatric neurology consultants are Dr Andrew Curran, Dr Rachel Kneen, Dr Ram Kumar, and Dr Stefan Spinty, who each have areas of special interest as described below. The departmental ethos is forward-looking and offers consultant-delivered care.
The Epilepsy Service provides a comprehensive and holistic service across the North West and North Wales and also outside the region. The service is supported by 1.5 WTE Nurse Specialists in paediatric epilepsy. The Roald Dahl EEG Unit, staffed by 3WTE senior, Highly-Specialised EEG physiologists (neurology), a Consultant Clinical Neurophysiologist (Dr Brian Tedman) provides an EEG service for Alder Hey and eight District General Hospitals. The EEG service includes routine and ambulatory EEGs and video-EEG telemetry (surface and invasive) and intra-operative cortical mapping.
Alder Hey, in conjunction with Manchester Children’s Hospital, is one of four nationally-commissioned centres for children’s epilepsy surgery services (CESS) in England. It is envisaged that the Alder Hey and Manchester CESS (termed ‘NorCESS’) will provide the epilepsy surgery service for the North of England and Northern Ireland. Miss Sasha Burn, Consultant Paediatric Neurosurgeon, is the surgical lead for the Alder Hey site.
The Epilepsy Service also includes a dedicated multi-disciplinary ketogenic diet service which provides a regional but also supra-regional service. This is led by Dr Rachel Kneen, Consultant Paediatric Neurologist. The service has 1 WTE dietician.
The Epilepsy Service has a national and international reputation for the clinical care of children with epilepsy, teaching and active research, specifically in the diagnosis and management of the paediatric epilepsies.
The inpatient management of acquired brain injuries is provided by the paediatric neurology department (main clinical input from Dr Ram Kumar and Dr Andrew Curran) in conjunction with a multidisciplinary therapy team (“HIRT – Head Injury Rehabilitation Team”). There are weekly team meetings. There are approximately 50 complex neurorehabilitation patients referred from within the hospital each year, predominantly from neurosurgeons, oncologists and PICU. Currently all the paediatric neurologists share in the clinical management of these patients.
Spasticity Service (led by Dr Ram Kumar)
The spasticity service is a multidisciplinary service for children with tone disorders run in conjunction with a specialist physiotherapist. Multidisciplinary clinics with orthopaedics, neurosurgery and upper limb surgery are held regularly. Interventions provided include botulinum toxin for upper and lower limbs, intrathecal baclofen, selective dorsal rhizotomy and deep brain stimulation.
Neuromuscular Service (led by Dr Stefan Spinty)
The regional neuromuscular service at AHCH has expanded very considerably over the years and continues to expand with monthly referrals averaging now 8.6. It is now one of the larger paediatric neuromuscular services in this country with a patient caseload of approximately 550.The established enthusiastic and comprehensive neuromuscular multidisciplinary team consists of a consultant lead (Dr Spinty), an associate Specialist in neuromuscular diseases, Neuromuscular Care Advisors, and fully-supported by a dedicated neuromuscular multidisciplinary therapy team. There is a weekly neuromuscular MDT meetings, eight dedicated weekly neuromuscular clinics including joint specialist orthopaedic, spinal, neuropathy and arthrogryposis clinics. There are monthly joint neuromuscular cardiac, endocrine and LTV multidisciplinary meetings and three monthly joint spinal meetings.
This new service started in 2012 due to the increasing recognition of autoimmune limbic encephalitis. Dr Rachel Kneen runs this service with the rheumatology team. Dr Kneen also has a clinical and research interest in CNS infectious diseases. Liverpool has an international reputation for research into CNS infection and the department is involved with running a course, teaching and different research projects in this area.
There are 3 specialty registrars of ST4+ (Specialist Registrar) level, an ST3 specialist registrar and an F2 grade doctor (SHO level) allocated to the department by the Mersey Postgraduate Deanery on a rotational basis. One of the ST4+ level doctors is a National Grid Trainee in Paediatric Neurology. There is a full paediatric neurology teaching programme, with additional sessions from individual consultants.
The neurology ward staff are trained and experienced in caring for children with a range of both acute and chronic neurological problems, including the medium and long-term rehabilitation of children with traumatic and non-traumatic brain injuries. Cross-training with the neurosurgical ward nursing staff is under way, pending the eventual integration of the two wards in the new Children’s Health Park Neurosciences ward.
The neurology inpatients benefit from access to a comprehensive range of specialist therapists from physiotherapy, occupational therapy, speech and language therapy, clinical psychology with additional neuropsychological expertise. The educational rehabilitation unit sited within the neurology ward allows assessment and educational re-integration of children following brain injury, including those who have been discharged.