Our Division of Paediatric Neurology aims to improve the quality of care offered to infant, children and adolescents with acute and chronic neurological disorders affecting the brain, nerves and muscles.
Led by senior paediatricians, the team comprises paediatricians, nurses and allied health staff who are also actively involved in patient care and translational research.
Adjunct Associate Professor Lawrence Wang
Our team treats children with a variety of conditions including:
Early intervention and rehabilitation is required for children with neurological disorders that affect their physicality. This includes conditions affecting the brain such as cerebral palsy, global developmental delay, and nerve and muscle disorders such as Duchenne muscular dystrophy and spinal muscular atrophy.
Our physiotherapist services provide family-centric and multidisciplinary support by:
We help to enhance the care of a child with complex needs by:
Our rehabilitation service provides comprehensive care for patients with spasticity who may require special seats or wheelchairs. Objective assessments are provided by the paediatricians specialising in neurology, the surgeons specialising in orthopaedics, the orthotists, the physiotherapists and occupational therapists, and gait is objectively analysed with portable gait analysis. Children with cerebral palsy have a comprehensive review to decide on the most appropriate mode of treatment – be it intramuscular botulinum toxin injection for specific muscle groups, special orthotic devices, or tendon-release orthopaedic surgery. Therapies such as robotic rehabilitation is also available in collaboration with the Centre for Advanced Rehabilitation Therapeutics (CART) in Tan Tock Seng Hospital. Preventative care such as hip surveillance, nutritional support and educational intervention are other critical arenas considered in our specialised clinics.
We provide diagnostic services, comprising electroencephalograms performed by experienced technicians and interpreted by paediatricians specialising in neurology and epileptology. Brainstem auditory-evoked response and visual-evoked potentials allow testing in children with suspected hearing or visual impairment respectively. Neuromuscular problems are also diagnosed and assessed with nerve conduction studies and electromyograms.
The Paediatric Epilepsy-Monitoring Unit (PMU) is designed especially for round-the-clock monitoring of patients diagnosed with epilepsy where more information is needed, or to clarify the nature of the patients' frequent spells or events. The patient (neonate, infant, child or adolescent) is admitted to the PMU to allow careful study of the clinical seizures or events.
The monitoring process involves continuous electroencephalogram (EEG) recording with simultaneous video recording of the seizures. The analysis of these seizures or events will enable an accurate diagnosis to be made and allow formulation of management plans that include anti-epileptic medication, ketogenic diet as well as the possibility of surgical treatment for intractable seizures.
There are clinic sessions run by a team of paediatricians with support from physiotherapists, occupational therapists, speech therapists, paediatric epilepsy nurse educator, child psychologists and the medical social worker.
There is also co-ordination of care for children with chronic problems. We work closely with special schools for children with spasticity, multiple handicaps and learning disorders. At the general paediatric neurology clinic, we provide for the diagnosis and management of children with neurological disorders, screening of neuro-developmental disorders and comprehensive care of inherited neurological disorders.
Our team is also actively involved in the Back to Sleep programme which helps to improve the sleep quality of children with complex medical needs.
Our multidisciplinary combined clinic provides comprehensive care for children and adolescents diagnosed with progressive neuromuscular conditions such as Duchenne muscular dystrophy, spinal muscular atrophy as well as congenital myopathies and other muscular dystrophies. Our clinics are held every month and cater to specific groups such as the independent walkers as well as the wheelchair dependent patients. Objective assessments are provided by the paediatricians specialising in neurology, pulmonary and sleep, orthopaedics and cardiology as well as physiotherapists, occupational therapists and orthotists.
This allows an integrated review of all the associated complications that often arise in this group of patients, and allow a comprehensive management plan to be made at a single setting.
Our neurogenetic clinic is held on the last Monday of the month. It is a combined service run by a paediatrician specialising in neurology and a paediatrician specialising in genetics. The clinic focuses on the diagnostic work up and management of neurogenetic, neurodegenerative and neurometabolic disorders.
NUHkids is very grateful to Ronald McDonald House Charities (RMHC) Singapore for being the sole grantor for the Back to Sleep programme. This programme aims to improve the sleep quality of children with complex medical needs. Children with severe neurological conditions and multiple medical needs are not able to turn or reposition themselves comfortably while sleeping. Their conditions manifest in abnormal muscle tones and postures, which often results in significant sleep disturbances and thus, short sleep duration. As parents have to keep waking up to reposition their child several times a night, the entire family then suffers from chronic sleep deprivation.
The Back to Sleep programme involves a multidisciplinary approach to evaluate each child's risk factors and to determine if sleep quality can be improved by providing a more comfortable sleeping surface with greater support. The team includes doctors, physiotherapists, nurses, the patients as well as their parents and caregivers. After other medical and behavioural causes of sleep disturbance are ruled out, the children are then fitted with the most appropriate sleep system to help improve their sleep.
The Back to Sleep programme aligns with our mission to provide excellent clinical care for children with medical needs as well as with RMHC's mission of supporting programmes that "directly improve the health and well-being of children". As this programme not only benefits the child but also the caregivers, it illustrates RHMC's belief that "when you change a child's life, you change a family's, which can change a community and, ultimately, the world".
In addition to clinically documented improved sleep quality and duration in these children, the project has made a positive impact on family life, as reported by some of the parents of the children and one of the older beneficiaries. In several families, the improved sleep quality had a huge effect on the medically frail children who have displayed improvements not only in mood but also appetite, thereby improving their quality of life. Parents and caregivers have also reported that they are better rested, underlining the importance of this intervention in improving family function.
In conclusion, a total of 48 children were direct beneficiaries of this programme, and an additional 210 family members and care givers were positively impacted.
Image 1 (from left): An example of one of the sleep systems. Images 2, 3, 4 and 5: They are 2 of the 48 direct beneficiaries of the Back to Sleep Programme. In both patients, their conditions manifest in abnormal muscle tones, movements and postures, which often result in significant sleep disturbances and poor sleep duration. Images 2 and 4 show the patients with poor postures when there is no support system, causing extra strain on their spines, body hips and knees. Images 3 and 5 show that their postures are supported, where their arms, body and legs are more relaxed, allowing them to sleep more comfortably.
We have an active clinical and basic research programme covering areas of epilepsy treatment and epidemiology, neurogenetic and neurometabolic disorders, botulinum toxin in childhood spasticity, encephalitis and other central nervous system infections and neuromuscular disease. Areas of research focus include the genetic and disease pathophysiology of Duchenne and Becker muscular dystrophy, mitochondrial encephalomyopathies and care of chronic neurological disorders.
Your child will have a comprehensive evaluation by our paediatrician specialising in neurology and based on the findings during the first appointment, relevant investigations including blood tests, EEG or neuroimaging (MRI brain) may be ordered. Subsequently, medications and other forms of therapy will be prescribed accordingly.
Click here for directions on how to get to the Khoo Teck Puat – National University Children’s Medical Institute (NUHkids) from the MRT, for drop off as well as parking.
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