Neurology

Your brain is the central command centre of your body. It sits within your skull and sends messages to other parts of the body via your spinal cord. Your brain and spinal cord make up your central nervous system and are protected by layers of bone, tissue and a clear, colourless fluid (cerebrospinal fluid).

• Messages are carried to and from your central nervous system to other parts of your body by neurones and nerve impulses.
• Did you know different parts of your brain control different parts of your body?
• The biggest part of your brain is the cerebrum, and this is the ‘thinking’ part. It is split into two halves; the right side interprets pictures, shapes and colours while the left side controls your analytics and data e.g., your speech and counting.
• The part of your brain that controls movement, balance and coordination is called the cerebellum.
• Your hypothalamus controls your body temperature and will tell your body when to sweat or shiver. Your ideal body temperature is 37 degrees Celsius.
• A very small but important part of your brain is the pituitary gland. This produces and releases hormones into your body.
• Your brain is connected to your spinal cord by your brain stem, which is involved in all the functions that keep you alive such as breathing and circulation. All information passes through your brain stem on its way to and from your brain.
• Your emotions and fears are controlled by the amygdala.

Did you know you probably have around 150 billion nerve cells in your brain?!

Access to tertiary neurologist advice and support

The Paediatric Neurology consultants at Alder Hey no longer provide a 24/7 on-call service. The new pattern of working is as follows:

• Neurology Consultant on call from 09.00-17.00 Monday to Friday
• Available for telephone advice 10.00 – 13.00 on Saturday and Sunday

All referrals to Neurology should be made via the Patient Pass system.

Referrals for advice on inpatient care are screened daily by the neurology team, but for urgent advice, please always follow any referral with a phone call to the neurologist as early as possible during the above hours.

Outpatient referrals are reviewed weekly by the team and you will receive a response via the Patient Pass system. This may take the form of advice and guidance where appropriate.

From 1st June 2024 we will no longer be accepting referrals that do not come via the Patient Pass system.

We have made several clinical guidelines available to support clinical teams. Please note these guidelines are only intended for use by clinical professionals only, and should not be used for any other purpose by members of the public.

About the Consultant Paediatric Neurologists

The paediatric neurology consultants are Dr Rajesh Karuvatiiln, Dr Rachel Kneen, Dr Rajesh Madhu, Dr Stefan Spinty, and Dr Ramiah Ramalakshmi who each have areas of special interest as described below. The departmental ethos is forward-looking and offers consultant-delivered care.

Super-speciality areas

Epilepsy service

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 Nurse Specialists in paediatric epilepsy. The Roald Dahl EEG Unit, staffed by 3WTE senior, Highly Specialised EEG physiologists (neurology), a Consultant Clinical Neurophysiologist (Dr Antonio Valentin) 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. 

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 and supported by specialist Dieticians.

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 paediatric epilepsies.

Neurorehabilitation service

The inpatient management of acquired brain injuries is provided by the paediatric neurology department (main clinical input from Dr Ramiah Ramalakshmi) in conjunction with a multidisciplinary therapy team (“HIRT – Head Injury Rehabilitation Team”). There are weekly team meetings. Complex neurorehabilitation patients are referred from within the hospital and from other units around the country, predominantly from neurosurgeons, oncologists and PICU. Currently, all the paediatric neurologists share in the clinical management of these patients.

Spasticity service

The spasticity service (led by Dr Ramiah Ramalakshmi) 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

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 Rajesh Madhu), consultant care from two other consultant neurologists (Dr Stefan Spinty and Dr Rajesh Karuvattil), clinical fellows in neuromuscular diseases, and Neuromuscular Care Advisors, and fully supported by a dedicated neuromuscular multidisciplinary therapy team. There are weekly neuromuscular MDT meetings, and 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 joint spinal meetings.

Neuroinflammatory service

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.

Supporting staff

There are 3 speciality 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 underway, pending the eventual integration of the two wards in the new Children’s Health Park Neurosciences ward.

Neurology inpatients benefit from access to a comprehensive range of specialist therapists from physiotherapy, occupational therapy, speech and language therapy, and 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.