Centers & Services

Department of Child Neurology

What is child neurology?

Child neurology, or pediatric neurology, treats various pediatric neurological diseases and disorders. Although the importance of child neurology has been well acknowledged in other economically developed countries, hospitals with a department specialized in child neurology remain few in number in Japan. Therefore, we have accepted referrals from various places in addition to the Chugoku and Shikoku regions.

Our physicians

Director , Department of Child Neurology

Katsuhiro Kobayashi Professor
[ Neurophysiological testing, EEG, and diagnostic imaging ]

Staff

Tomoyuki Akiyama Associate Professor [Pediatric epilepsy, neurophysiology, and neurometabolic disorders]
Makio Oka Lecturer [Behavioral development and pediatric epilepsy]
Fumika Endo Lecturer [Pediatric epilepsy and severe psychosomatic disorder]
Mari Akiyama Assistant Professor [Pediatric epilepsy and behavioral development]
Harumi Yoshinaga Visiting Professor [Pediatric epilepsy, severe psychosomatic disorder, and electroencephalography]
Nagako Murakami Part-Time Lecturer [Pediatric epilepsy and developmental testing]
Takushi Inoue Visiting Researcher [Pediatric epilepsy and neuromuscular disorders]
Akihito Takeuchi Visiting Researcher [Behavioral development]

*Specialty indicated in [ ]

Outpatient physicians and clinical sections available by day of week

Monday Tuseday Wednesday Thursday Friday
9:00 - 12:00 AM Kobayashi Hayashi T. Akiyama Oka T. Akiyama Murakami Kobayashi Endo Endo Yoshinaga
(Outpatient appointments only)
13:00 - 17:00 PM
EEG • evoked response
(T. Akiyama)
Behavioral development
(Oka)
EEG • evoked response
(T. Akiyama)
EEG • evoked response
(T. Akiyama)
Behavioral development
(M. Akiyama)
EEG • evoked response
(M. Akiyama)
Behavioral development
(Oka)
EEG • evoked response
(Endo, Yoshinaga)

Treatment system

Professor: Katsuhiro Kobayashi
Associate Professor: Tomoyuki Akiyama
Lecturer: Makio Oka, Fumika Endo
Assistant Professor: Mari Akiyama

Treatment policy

Because treatment is performed for children with various disorders, we treat not only the disease itself but also endeavor to resolve or alleviate aspects of problems of patients and their families in the course of development in collaboration with communities and schools, and with primary care physicians who issue referrals.

Specialties

We cover pediatric neurological diseases and mainly provide internal treatment. We have continued to achieve prominent results in Japan in the treatment of epilepsy, particularly refractory epilepsy. Developmental disorder, behavior disorder, and cerebral palsy are also important fields. Refractory epilepsy is also treated surgically in collaboration with the Department of Neurosurgery.

Scope of Target diseases

  • Convulsive disorder
    Pediatric epilepsy, particularly refractory epilepsy
    Begin convulsion such as febrile convulsion
    Convulsion-related disease
  • Developmental disorder • behavior disorder
    Autism spectrum developmental disorder
    Attention deficit hyperactivity disorder (AD/HD)
    Learning disabilities(LD), language disorder
    Intellectual disability
  • Neuromuscular disease
    Peripheral neurological diseases
    Muscular disease such as muscular dystrophy
  • Pediatric motor disorder such as cerebral palsy
  • Sleep disorder(such as sleep apnea syndrome and restless legs syndrome)
  • Metabolic and degenerative disease and encephalopathy
  • Cerebrovascular disorder, etc.

Description of medical care

Although child neurology has been regarded as a specialty from early times in the United States and Europe, the establishment of a specialized hospital department has been delayed in Japan, exceptionally among developed countries. Only two university hospitals in Japan have a hospital department specializing in child neurology. For that reason, many patients with pediatric neurological disease are referred to us evey day from places in western Japan, mainly the Chugoku and Shikoku regions.
The outpatient clinic of child neurology treats pediatric neurological diseases including epilepsy and other convulsive disorders, cerebral palsy and intellectual disability, developmental disorder such as language and learning disabilities, behavior disorders, autism, muscular disease, metabolic and degenerative disease, and cerebrovascular disorder. The clinic is open every day from Monday through Friday for both initial and return visits. We also offer special outpatient services of developmental testing (Wednesdays), learning disabilities clinic and behavior disorder and autism clinic (Mondays, Wednesdays, and Thursdays). Developmental testing provides continuous observation and consultation for children who have been identified in general infant health examination as having some disorder or symptom.
In principle, consultation is done during the morning. However, examination including intelligence tests is performed for learning disabilities, behavior disorders and autism, etc. Therefore, there is insufficient time for these in usual outpatient consultation. Outpatient clinics for behavior disorder, autism and learning disabilities are available for appointments in the afternoon on Mondays, Wednesdays and Thursdays to examine each patient for an appropriate duration.
In addition, convulsive disorders including epilepsy are extremely frequent among pediatric neurological diseases. Electroencephalography (EEG) is available every day from Monday through Friday so that the diagnosis and treatment of convulsive disorder can be addressed rapidly. EEG results and treatment policies are explained immediately after EEG within the same day. This system is favorably accepted by patients and physicians whoreferred them to us. See here for our medical school department.

For outpatient visits

Appointments should be made for electroencephalography (EEG), in principle, either by an attending physician during consultation, or by return postcard. When a patient is referred to us for the first visit, we make efforts to perform EEG on the same day. However, if it is not possible to perform EEG on the same day, it must invariably be performed on a return visit. The Department of Child Neurology still has only 10 beds. There always are patients waiting for hospital admission. Although priority will be assigned in cases of emergency, we appreciate your understanding that hospital admission is almost impossible on the day of the first visit.

Special medical care in child neurology

  • Special EEG: For refractory epilepsy, in addition to common EEG, simultaneous video recording of seizures and special analysis of digital data (EEG topography, dipole analysis, and frequency analysis) are conducted.
  • Surgical treatment of epilepsy: For the surgical treatment of refractory epilepsy, seizure recording with intracranial electrodes and preoperative evaluation are performed in collaboration with the Department of Neurosurgery.
  • Neuropsychological tests: These are important in the brain function evaluation in developmental disorder. In addition to general intelligence tests and language development tests, specialized higher brain function tests of cognitive function and frontal lobe function are conducted.

Main methods for testing and explanation

  • EEG and neurophysiology: Electroencephalography(EEG) is indispensable not only for the diagnosis of epilepsy and therapeutic efficacy evaluation. It is also important for brain function evaluation. See above for special EEG, Evoked potentials including auditory brainstem response, visual evoked potential and somatosensory evoked potential. Nerve conduction testing is performed for peripheral neurological disease.
  • Intelligence tests: Intelligence tests are performed to diagnose developmental disorders. More specialized psychological tests are presented above.
  • Neuroimaging: In addition to MRI, CT, and cerebral blood flow scintigraphy, functional MRI and PET are performed depending on the disease.

Main testing methods and medical equipment

EEG

We perform about 3,000 EEG recordings annually. Special optical stimulation testing is also available for the diagnosis of video game epilepsy or TV epilepsy. Overnight polysomnography is also performed for the diagnosis of sleep disorders.

Simultaneous EEG- video analysis

For inpatients, EEG and electromyography are performed with simultaneous video recording for the diagnoses of seizure type and nonconvulsive phenomena.

Neurophysiology

In addition to auditory brainstem response (ABR), visual evoked potential (VEP), somatosensory evoked potential (SEP, SSEP), and event-related potential (P300), patients with peripheral neurological diseases are also diagnosed using nerve conduction study.

EEG Analysis

Noninvasive diagnosis of epileptic focus is performed using state-of-the-art EEG topography and dipole analysis with precise EEG records using digital electroencephalography.

Metabolic and genetic tests

For metabolic disease, genetic diagnosis is available in cooperation with research institutions in various places in addition to in-house metabolic tests such as amino acid analysis.
Genetic diagnosis of epilepsy is also performed in cooperation with the basic research division in our hospital. Chromosomal diagnosis by the Microarray method is also available.

Intelligence tests

In addition to general intelligence tests and language development testing, we provide the specialized psychological/educational assessment battery (K-ABC), Illinois test of psycholinguistic abilities (ITPA), and other higher brain function tests to ascertain the pathological condition of language or learning disabilities.

Various diagnostic imaging

In addition to MRI and CT, SPECT (including ictal) and MR spectroscopy are performed for inpatients. PET has also become available.

Preoperative evaluation for epilepsy surgery

We conduct scalp EEG, ictal EEG with intracranial electrodes, neuropsychological evaluation, and determination of the language dominant hemisphere using functional MRI.