Child Neurology Division

The Child Neurology Division was established in 1974. Over the last 30 years it has grown into an academic division of national and international reputation.

The Division has implemented several research projects of the World Health Organization; Department of Science & Technology; Medical Research Council, UK; Indian Council of Medical Research; Department of Biotechnology and All India Institute of Medical Sciences, New Delhi.  It has made significant contributions towards development of the specialty, education and  reduction of childhood neuromorbidity.

Activities include clinical work, training, initiation of DM (Child Neurology), advocacy, research and networking

Faculty and staff

Head, Child Neurology Division           Professor Veena Kalra, MD, FAMS, FNASc
                                                 Chief, Child Neurology Division
                                                 Head, Department of Pediatrics
                                                 All India Institute of Medical Sciences
                                                 Ansari Nagar, New Delhi-110 029
                                                 Phone: +91-11-26593209, +91-11-26594424
                                                 Fax:     +91-11-26588663
                                                 Email: kalra_veena@hotmail.com; kalra.veena@gmail.com

 Co-ordinator                                       Dr. Sheffali Gulati, MD
                                                             Associate Professor, Child Neurology Division
                                                             Department of Pediatrics
                                                             All India Institute of Medical Sciences
                                                             Ansari Nagar, New Delhi-110 029
                                                             Phone: +91-11-26588500, 26588700 extn 4679
                                                             Fax: 91 11 26588663
                                                             E-mail:sheffalig@yahoo.com;   sheffaligulati@gmail.com

Staff:

Mrs. Savita Sapra, Child Psychologist
Mrs. Sumita Gupta, Physiotherapist
Mrs Sushila, EEG technici

Patient services: (OPD, Inpatient, Lab services)

Facilities for Patient Care

  • OPD: Tuesday & Friday: Room No. 3 & 9; 9 am onwards
  • Developmental Clinic: Monday: Room No: 12, 13; 2 pm onwards: For patients with developmental delay/ regression and High Risk follow up.
  • Neurocysticercosis clinic: Monday: Room No. 8; 2 pm onwards
  • Pediatric Neurology Clinic(PNC): Wednesday: Room No 7,8, 14; 2 pm onwards:- New cases & PNC file by appointment:- Counter in OPD; Old cases appointment:- Room 8 in OPD on Wednesday 2pm onwards or Room 3058 Pediatric Office (Mr Suresh): Caters to patients with a wide spectrum of neurological problems including epilepsy, stroke, ataxia, degenerative brain disease, cerebral palsy, mental retardation etc. Annual registrations: Approximately 6500 old and 2000 new cases.
  • Myopathy Clinic: Friday: Room No: 7,8; 2 pm onwards: Caters to patients with a wide spectrum of neuromuscular disorders including muscular dystrophies, congenital myopathies, hereditary neuropathies, spinal muscular atrophy and acute flaccid paralysis. Annual registrations: Approximately 1150 old and 250 new cases.


Inpatient Services
Pediatrics Unit II: C V ward

Investigations available:

                              Pediatrics Department Room No. 3057
                              Incharge: Professor Veena Kalra
                         Contact person: Dr. Sheffali Gulati
                        EEG technician: Ms Sushila

·       Blood Lead estimation: Appointment from Pediatric Department room no. 3055/ 3057 or Tuesday/ Friday 9am onwards in Room No.3, 9 or Wednesday 2 pm onwards in Room No. 8, 14.

·        Needle electromyography: Tuesday, Thursday 2.00 pm onwards in Room No. 3057. Appointment from Room 3055/ 3057 or Tuesday/ Friday 9am onwards in Room No. 9 or Wednesday 2 pm onwards in Room No. 8, 14.

·        Motor nerve conduction studies, sensory nerve conduction studies, F wave: Tuesday, Thursday 2pm onwards in Room No. 3057. Appointment from Room 3055/ 3057 or Tuesday/ Friday 9am onwards in Room No. 9 or Wednesday 2 pm onwards in Room No. 8, 14

·        Brainstem auditory evoked responses: Tuesday, Thursday 2pm onwards in Room No. 3057.  Appointment from Room 3055/ 3057 or Tuesday/ Friday 9am onwards in Room No. 9 or Wednesday 2 pm onwards in Room No. 8, 14

·        Visual evoked responses: Pattern and Flash: Tuesday, Thursday 2pm onwards in Room No. 3057. Appointment from Room 3055/ 3057 or Tuesday/ Friday 9am onwards in Room No. 9 or Wednesday 2 pm onwards in Room No. 8, 14

·        Electroencephalography: All 6 working days a week in Room No. 3057. Appointment from Room 3057/ 3058 Mrs Sushila

·        Blood/ CSF Lactate: Through Pediatric Unit II Senior resident Place: CV ward; Criticare lab, DV ward

·        DQ, IQ, Behavioral assessment, stimulation: Prior appointment. Place: Pediatric OPD Room no. 6 on Tuesday, Friday 9am onwards; Wednesday 2pm onwards, Room No 6; Monday 2pm onwards in Room No. 3. Contact person: Mrs Savita Sapra

      Charges levied for any tests so far:
      EEG: Rs 200/-

 Research

List of research work done/ in progress

Seizures/ epilepsy

·       Febrile seizures: Role of per rectal diazepam; trial of oral diazepam versus clobazam; rectal diazepam versus oral phenobarbitone

·        Acute childhood seizure: Intranasal Midazolam versus per rectal diazepam

·        Evaluation of intractable seizures: causes, early markers, investigations in intractable epilepsy – MRI epilepsy protocol, SPECT, EEG, Presurgical work up.

·        Drug trials- clobazam, lamotrigine, vigabatrin, Divalproate

·        An international phase 3 study titled “A Randomized, Open Label, Multicenter Study With Open-Label Extension of the Pharmacokinetics and Safety of Topiramate Administered as the Oral liquid and Sprinkle Formulations as an Adjunct to Concurrent Anticonvulsant Therapy in Infants (Aged 1 to 23 months, Inclusive) With Refractory Partial-Onset Seizures” (Protocol TOPMAT-PEP-1002 Phase I”

·     Trials for Neurocysticercosis-Anti – epileptic drug regimens cysticidal drug trials, community intervention programme, low dose regime for multiple NCC.

·       Effect of short term phenytoin monotherapy on bone mineral density in ambulatory epileptic children.

·        Study of antinuclear antibody and antiphospholipid antibody in intractable epilepsy.

Neuroinfections

·        Role of countercurrent immunoelectrophoresis, LDH, LDH isoenzymes, ADA in CNS infections

·        Viral encephalitis: Identification of Japanese B encephalitis using indirect immunoflouresce in CSF, virus isolation from CSF using C6/36 line of continuous Aedes albopictus cells and detection of Japanese encephalitis specific IgM antibody in CSF and serum by MAC-ELISA.

· Newer therapeutic options: Intrathecal Alpha-interferon therapy in sub-acute sclerosing panencephalitis.

·        Unusal CNS infections

Neurocysticercosis

·        Clinical profile and epidemiology of Neurocysticercosis

·        Diagnosis of Neurocysticercosis: Blood/CSF ELISA; Study of toxoplasma and cysticercal antibodies in blood & CSF of patients with inflammatory granulomas.

·        Cysticidal therapy in Neurocysticercosis: Short course (8day) oral albendazole; 28 day Albendazole  trial in  one or two ring lesions; Randomized controlled trial of Albendazole (28 days) versus high dose Praziquantel(1 day); Dexamethasone Versus albendazole; low dose regime albendazole in multiple NCC

·      Retrospective analysis to study calcification as a risk factor for epileptogenecity in neurocysticercosis; Is calcification epileptogenic in neurocysticercosis? - A Study of Single Photon Emission, Computed Tomography, Electroencephalography and Computed Tomography

·        Community education programme in 24 MCD  primary schools in Delhi; Health education interventions among school children for prevention of taeniasis and neurocysticercosis; Risk of seizures and neurocysticercosis among children with Taeniasis and their household contacts.

·       Prospective randomized double blind controlled trial of dexamethasone versus albendazole on calcification as an outcome in 1-2 ring enhancing lesions in neurocysticercosis in children.

Learning disabilities

·        Development of a computer based kit for children with Learning Disabilities.

·        Awareness school intervention programme

Neuromuscular disorders

·        Clinical spectrum of Xp21 myopathies, immuno-histochemical characterization and gene deletion; Corticosteroids trial in Duchenne Muscular Dystrophy.

·        Cardiac function in non-ambulatory children with Duchenne Muscular dystrophy or those with advanced disease; Cardiac dysfunction in Becker muscular dystrophy and Duchenne Muscular Dystrophy carriers.

·        Clinico electrophysiological genetic studies on floppy children (SMN and NAIP gene deletion studies).

·        Randomized Double blind placebo controlled trial of Gabapentin in children with Spinal Muscular Atrophy.

·        A randomized open label placebo controlled study of the effect of creatine supplementation on muscle P31 MRS spectra in Duchenne muscular dystrophy. 

Acute Flaccid paralysis

·        Molecular, Biological and serological detection of parameter of association of campylobacter jejuni infection in children with Guillain Barre syndrome.

·        Detection of polio and non polio enteroviruses by polymerase chain reaction in poliomyelitis and aseptic meningitis.

·        Clinical, virological and neurophysiological study on acute flaccid paralysis in children.

·        Intravenous immunoglobulin therapy in patients with Acute - Guillian Barre syndrome.

Malnutrition

·        Neurobiological effects of Vitamin E deficiency in malnourished children

·        Magnetic resonance spectroscopy in Protein Energy Malnutrition.

Lead

·        Evaluation of the severity and prevalence of plumbism in different population groups in Delhi

·       Zinc protoporphyrin as a screening test for lead toxicity and lead exposure among Delhi children.

·        Lead in Attention Deficit Hyperactivity disorders ( ADHD).

·        Lead  Pollution and Health in Delhi – A follow up study.

Headache

·        Prophylaxis of migraine: Randomized controlled trial of flunarizine versus propranolol.

Attention Deficit Disorders

·        Role of  Mentat in Attention Deficit Disorders (ADD).

·        Atomoxetine trial

Cerebral Palsy

·        Role of botulinum toxin in reducing spasticity in children with CP.

·        A double blind placebo controlled trial to study the efficacy of Baclofen in reducing tone in children with spastic Cerebral palsy 2-5 years of age.

·        Role of autologous stem cell transplantation in cerebral palsy.

 

Neurometabolic disorders

·        Evaluation of all cases with suspected neurometabolic disorders and initation of therapeutic interventions wherever available

Autistic Spectrum Disorders

·        Autism network established- Screening tests, autism rating scales and drug trials with Resperidone, Olanzepine under Indo-US Science & technology Collaboration, Training resource material developed, Awareness generation, networking with NGOs& parents, Registry for Autism initiated in Delhi.

·        Rett syndrome: Clinical evaluation, genetic evaluation, stimulation and therapeutic trials.

·        “ Molecular Genetic studies in Indian children with Rett syndrome.”  

Laser therapy

·        The effect of low level laser therapy in "common childhood illness" under the National Laser Programme sponsored by the Department of Atomic Energy.

·        Helium Neon laser therapy for prophylaxis of recurrent throat infection.

·        Semiconductor diode laser therapy for nocturnal enuresis.

·        Helium Neon laser therapy in would healing, children with multidrug resistant infections, chronic lymphadenitis.

Indian Childhood Cirrhosis

·        Multifaceted studies on epidemiology, National collaborative study

·         Role of D-Penicillamine in Indian Childhood Cirrhosis, immune mediation, complement profile .

 

Role of Single Photon Emission Computed Tomography in

·        Childhood intractable epilepsy

·        Tuberous sclerosis

·        Attention Deficit Hyperactivity Disorder (ADHD).

 

Magnetic resonance spectroscopy in various neurological disorders

·        Persisting ring lesions in neurocysticercosis

·        Megalencephaly and leukodystrophy

·        Attention deficit hyperactivity disorders

·        Friedreich ataxia base line and on follow up while on a therapeutic trial

·        Tuberous sclerosis

·        Neurocysticercosis/ Tuberculoma

·        Rett syndrome

·        Leighs disease

Cerebrovascular disease

  • Study of etiological risk factor profile in Pediatric strokes
  • Role of autologous stem cell transplantation in Pediatric strokes

Leukodystrophies

  • A study of the spectrum of childhood leukodystrophies: Correlation with imaging, spectroscopic and biochemical features.
  • Molecular Genetic studies in patients with Leukodystrophy especially Adrenoleukodystrophy  

Developmental delay

  • Etiological yield of comprehensive evaluation of Global developmental delay in young children.
  • A study of Gastroesophageal reflux by scintigraphy and ultrasonography in developmentally delayed children.
  • A randomized controlled trial of mosapride versus metoclopramide for treatment of Gastroesophageal reflux in developmentally delayed children.

Miscellaneous

  • Pilot study to evaluate brain-drain among graduates of the All India Institute of Medical Sciences, New Delhi
  • To study the cognitive and behavioral profile of children with celiac disease before and after the introduction of a gluten free diet and the various neuropsychiatric manifestations of celiac disease.
  • Prevalence of MTHFR C677T polymorphism in north Indian mothers having babies with Trisomy 21 Down Syndrome.
  • Evaluation of genetic polymorphism in MTHFR gene (C677T) as a risk factor for neural tube defect in offsprings.
  • Prevalence of spina bifida occulta in patients with enuresis and its relation to urodynamic and neurophysiologcal measurements.

  Training/ Courses

Under Graduate Training

Essential Pediatric neurology for MBBS undergraduate students, B.Sc. (Hons) Nursing students and B.Sc. (Hons) Speech and Hearing course.  Curriculum based on practical pediatric problems developed. 

Postgraduate Training

Junior residents (MD students) undergo specialty training for 6-8 months during the 3-year residency programme. They attend teaching rounds, journal clubs, clinical case discussions, clinical combined rounds, grand rounds, radiology conference, mortality audit. Around 18 junior residents are registered for the 3 year MD training programme. Department conducts a Pediatric CME programme annually and inhouse updates/ programmes 2-3 times per year.

DM (Pediatric Neurology) training

Participate in the training activities of the Department and upgraded Neurology Child development training schedule. The DM students rotate through adult Neurology, Neurosurgery, Neuropathology, Neuroradiology, Neurogenetics, Research epidemiology and Electrophysiology in addition to Pediatric Neurology.

Training in Rural Services   

The AIIMS has a rural outreach project located 35 km away for training and research. This Comprehensive Rural Health Services Project (CRHSP) caters to a rural population of 72,182 through 2 Primary Health Centres, 11 Extended Health Centers and a 60 bedded level II Hospital at Ballabhgarh. It  provides a unique opportunity for community-based training and research in Pediatrics and Pediatric Neurology.

Training opportunities:

In service training facility for short term (<3 months) and long term (³ 3 months) available to National candidates from the armed services, medical colleges and international candidates from the SAARC region. Training program includes approach towards neurological problems, rationalization of investigations, diagnosis, management and rehabilitation of cases in Child Neurology. It includes:

§         Clinical Child Neurology training in inpatients, Outpatient Department, Child Neurology Clinic, Neuromuscular Clinic, Developmental Clinic and Genetics Clinic.

§         Neuroradiology Conference: weekly to discuss CT and MRI scans.

§     Neuropathology Conference: monthly Interdisciplinary meet for muscle/ nerve/ brain/ skin  biopsies performed.

§         Neuroelectrophysiological discussion (including EEG, EMG, motor and sensory NCV, BERA, VER).

§         Neurogenetic training.

§         Brief research projects to train in research methodology

 Applications for the same should be addressed to the Dean, AIIMS.

Training Modules

·        A training module has been developed for physicians working at the district and sub-district hospitals, and the primary health centers. The module was developed for the Expert Group Meeting for Upgrading the Training and Research Skills of Pediatricians of SAARC countries for Reduction of Childhood Neurological Morbidity (15-19 January 2000).  

·        An educational video on Cerebral palsy and congenital malformations of the CNS developed under the above mentioned SAARC meeting.

·        Practical Pediatric Neurology: A comprehensive textbook on Pediatric Neurology

·        Development through Activity: A book for parents guiding them for stimulation

·        Pragya: A computer based kit for children with learning disability

·        Booklet on Pragya

·        Booklet on Autism

·        Booklet on Lead poisoning

·        Booklet on Neurocysticercosis

Other activities

  • Expert Group Meeting for Upgrading the Training and Research Skills of Pediatricians of SAARC countries for Reduction of Childhood Neurological Morbidity (15-19 January 2000)
  • International Child Neurology Education Conference (17-19 November 2000, New Delhi)
  • 2nd SAARC Group Meeting on Reduction of Childhood Neurolomorbidity (7-11 August 2002, New Delhi)
  • 8th Asian & Oceanian Congress on Child Neurology (7-10th October, 2004).

 Events/ notices