Pediatric Neurology

Neuropsychology is a unique field in Psychology that deals with the relationship between the brain and functioning. Almost all areas of cognitive, behavioral, and emotional functioning are influenced by the processes and structures in the human brain. Each of these areas could change following a change in the brain and any such change challenges the brain’s resources. The Neuropsychologist focuses on understanding how brain functioning influences a person’s ability to function at work, at home, and in school.

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The Neurogenetic Clinic diagnoses children with complex diseases that affect the development of the nervous system, which appears to have a genetic component, and also offers a therapeutic framework.

Please bring all the medical documents and the results of all the tests that have been conducted on the child or the mother during pregnancy to the appointment at the clinic. If there are additional data about the health status of other family members that may be relevant to the child's condition, please bring them as well.

During the visit, a medical history is gathered, and a family tree is constructed. The children are invited along with their parents, and sometimes their healthy siblings, for a comprehensive neurological assessment conducted by the two doctors.

After this examination, there is a consultation regarding each patient, determining the recommended genetic clarification for their condition. The parents receive a detailed letter with recommendations for further tests, and follow-up takes place several months after the progress of the clarification and treatment.

Cerebral Palsy (CP) presents a highly complex therapeutic and rehabilitative challenge, as it involves integrating the child into their family, educational, and occupational environment. The Pediatric Neurology Unit has a long-standing tradition of treating cerebral palsy, and one of its expressions is the establishment and medical management of the "Devora Agmon Alwyn Israel Rehabilitation Garden," located near the hospital. The diagnostic and treatment process for children with cerebral palsy is carried out by multidisciplinary teams, which, in addition to pediatric neurologists, include specialists in CP-specific physiotherapy, occupational therapy, communication, and neuro-rehabilitation psychology.

In the Pediatric Neurology Unit, there is a unique clinic for movement disorders, which is a common problem in cerebral palsy and may also be associated with other neurological diseases. Movement disorders result from impairments in the nervous system or muscles, leading to failures in movement planning and control. Clinical expressions of movement disorders range from hyperkinetic movements such as chorea and tremors to hypokinetic movements such as spasms and dystonia. These disorders can cause difficulties and impairments in both gross and fine motor functions, impacting the quality of life. The specialized clinic for movement disorders was established to address the complex diagnosis and provide pharmacological and rehabilitative treatment to improve coping with these challenges.

The multi-disciplinary clinic at Shaare Zedek Medical Center is designed to treat sleep disorders and sleep-related breathing issues in children. This unique clinic was established to provide comprehensive care for infants and children who suffer from respiratory problems and sleep disorders, taking a holistic approach. The clinic's team of specialists in pediatric otolaryngology, pediatric pulmonology, and pediatric neurology focuses on diagnosing, treating, and supporting the child and their family appropriately. The clinic also has a skilled nurse trained in CPR and monitoring use. Parents can directly contact the nurse from their home for advice whenever needed.

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In the pediatric neurology unit, there is a team of neuropsychologists who conduct assessments and provide treatment for learning abilities, emotional range, and cognitive function, with an emphasis on communication skills. The neuro-psychological or psycho-diagnostic assessment is an integral part of the neurological evaluation, especially in cases of psychomotor developmental issues, learning disabilities, or Attention Deficit Hyperactivity Disorder (ADHD). The assessment results include treatment recommendations and adaptations for implementation in various educational settings.

We attach great importance to the psychological assessment, even in children with primary neurological conditions such as epilepsy, considering its impact on their cognitive, emotional, and learning aspects. The psychological team offers guidance and support to parents of children with developmental delays, learning difficulties, behavioral disorders, or sleep problems. Collaboration between the psychological team and other professionals working within and outside the unit enhances treatment efficacy and contributes significantly to the well-being of the child and their family.

Attention Deficit Hyperactivity Disorder (ADHD) is characterized by difficulties in focusing, sustaining attention, impulsivity, and excessive activity. It affects about 5%-12% of the child population and can hinder their functioning at home, school, and in society. Sometimes, ADHD is manifested solely as inattention, but even adolescents and adults may suffer from it.

The diagnosis of ADHD is usually based on interviews with the child and their parents, behavior questionnaires, physical and neurological examinations, and cognitive tests. To further support the diagnosis and assess the attention component specifically, we now have access to a computerized test called MOXO. This test directly and objectively evaluates the individual's (child, adolescent, or adult) ability to sustain attention and concentration over time. The MOXO test is friendly to the examinee and lasts approximately 30 minutes. During the test, the examinee is asked to watch the computer screen and respond to a given stimulus while ignoring other distractions.

The key measures in the MOXO test include:

• Attention measurement, assessed by the responses to the target stimulus.
• Impulsivity, measured by the responses to non-target stimuli.
• Reaction time, indicating the efficiency of the examinee in task performance.
• Consistency in task performance.

The MOXO test is conducted in the pediatric neurology unit for examinees over the age of six, and its results have significant implications for diagnosing the attention component in ADHD. Additionally, the test can be repeated after the commencement of treatment, whether it's pharmacological, behavioral, or otherwise, to objectively assess the effectiveness of addressing this common issue.

* A referral from a physician is necessary if more than one test is required. Also, ensure relevant prescriptions and medication as instructed by the doctor.

* In case of a referral to two tests, both can be scheduled on the same day.

* Payment is separate for each test.

* A special arrangement is available with certain health insurance plans, so make sure to obtain a referral from a doctor and, if necessary, relevant prescriptions.

The Jerusalem Center for Autism Treatment and Research (JCA) in Shaare Zedek Medical Center is leading worldwide efforts to assist the most severe patients and their families by suggesting the option of medical marijuana. This treatment has a potentially better efficacy and tolerability compared with the standard treatment and we explore its effects in large, state-of-the-art studies that include hundreds of patients

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At Shaare Zedek Medical Center, one of the world's largest neonatology departments operates. The neurological service for newborns continuously monitors infants admitted to the Neonatal Intensive Care Unit (NICU) to provide early diagnosis and treatment for any neurological difficulties that may arise, including white matter injury, hemorrhage, infection, encephalopathy, seizures, and hypoglycemic injury.

To achieve this, advanced imaging techniques are utilized, including an MRI of the brain, which can be performed at the bedside without having to move the newborn to the MRI facility. Continuous EEG monitoring is also used at the patient's bedside. These tools assist infants with brain damage in developing optimally.

Our cutting-edge neurological care ensures that newborns in need receive the best possible treatment and support for their neurological conditions.

Epilepsy is prevalent among children, and its clinical manifestations are highly diverse. Despite early beliefs and misconceptions, the vast majority of children who receive proper treatment either recover or successfully manage the condition! While most children experience a single epileptic seizure, others may have recurrent seizures and require ongoing preventive treatment. Epilepsy can present with a wide range of clinical symptoms, from brief momentary absences to loss of consciousness, falls, and convulsions. Sometimes, it may be associated with difficulties in cognitive, learning, emotional, and behavioral domains.

Our Pediatric Neurology Unit has extensive experience in diagnosing and treating epilepsy, especially in children with complex or treatment-resistant cases. For our patients, the unit provides an advanced laboratory for Electroencephalography (EEG) where tests for alertness and sleep are conducted, including video and prolonged EEG monitoring throughout the night. Additionally, the unit offers specialized clinics for the treatment of epilepsy-related conditions, such as ketogenic diet, Vagal Nerve Stimulation (VNS), and Tuberous Sclerosis Complex (TSC).

The unit's team aims to provide comprehensive care for children with epilepsy, paying close attention to the cognitive, emotional, and behavioral difficulties that may arise during the course of the disease. To achieve this goal, a unique comprehensive epilepsy clinic was established within the unit. This holistic approach assists the child and their family in coping with all aspects of epilepsy. The clinic involves a multidisciplinary team, including a psychologist, social worker, clinical dietitian, and representatives from the Israeli Epilepsy Association.

In the past decade, there has been significant progress in identifying the human genetic code and understanding the inheritance mechanisms of various inherited diseases. There are inherited diseases that primarily affect the nervous system, which can lead to cognitive, motor, emotional, and behavioral disturbances in children from a young age.

Within the Pediatric Neurology Unit, there are multidisciplinary clinics designed to treat children with Prader-Willi syndrome. The Prader-Willi clinic in the unit serves as a national center for this syndrome and treats the majority of Prader-Willi patients in Israel. The clinic is led by Prof. Vered Gross-Tsur and includes a child psychiatrist, psychologists, orthopedists, geneticists, and clinical nutritionists, among others, to provide comprehensive care for the children and their families.

Pediatric Neurosurgery Consultation Clinic

The clinic provides consultation services by a senior pediatric neurosurgeon on various topics related to pediatric neurosurgery. This includes monitoring infants or babies who have suffered from intracranial hemorrhage or congenital malformations before or after surgery, follow-up for head injuries, follow-up after resection of nervous system tumors (brain or spinal cord), consultation for congenital skull deformities, hydrocephalus, and more.

Spasticity Surgeries

Neurosurgical procedures to reduce muscle tone in children with cerebral palsy and other conditions that cause chronic muscle tension from a source in the central nervous system (brain or spinal cord). Children with chronic spasticity may have a background of brain damage and white matter injury, asphyxia or hypoxia following birth-related events, post-resuscitation, severe head injury, or spinal cord injury. The treatment approach is multidisciplinary.

When a child presents chronic spasticity that complicates their treatment, interferes with physical therapy, causes pain due to spasm or increased tone, and also in cases of contractures and gait disturbances, a therapeutic option to reduce the tone is considered, in coordination with the neurologists and orthopedists treating these children. At Shaare Zedek Medical Center, there has been a multidisciplinary clinic for many years, which involves pediatric neurologists, orthopedists, pediatric neurosurgeons, occupational therapy, physiotherapy, and speech therapy. When the decision is made to reduce the tone to ease the child's condition, the child becomes a candidate for neurosurgical intervention.

The main therapeutic option in the neurosurgical aspect is the implantation of a baclofen pump, which is performed at the hospital. Afterward, the pump is regularly filled according to the team's guidelines. This filling is done on an outpatient basis and does not require anesthesia. Currently, there is a well-established system in the hospital that provides this service optimally.

In addition, there is an option called Selective Dorsal Rhizotomy (SDR) surgery, primarily suitable for children with spastic diplegia. Discussion and suitability for these children and their eligibility for surgery are carried out within the multidisciplinary clinic or spasticity clinic.