Neurology and Neurophysiology

The Division of Pediatric Neurology of the Montreal Children’s Hospital was founded in the 1960s, and was one of the first pediatric neurology divisions to be established in Canada.

Under the leadership of its first director, Dr. Preston Robb, a pioneer of pediatric neurology in Quebec, and later under the 25-year directorship of Dr. Gordon Watters (1969-1994), and a 10-year directorship of Dr. Bernard Rosenblatt (1995-2005), the division became a major national training site. Approximately 40% of Canada’s child neurology specialists have received training from the division, and have gone on to work at pediatric hospitals across the country.

The neurophysiology laboratory of our division was one of the first electroencephalography (EEG) units in North America dedicated exclusively to children. It is named for the late Dr. Katherine Metrakos, who succeeded Herbert Jasper as Director of the Neurophysiology Laboratory and founded the pioneering Convulsive Disorder Clinic. Working from the MCH, Dr. Metrakos and her husband Julius D. Metrakos, PhD, helped our current understanding of the epilepsies and how they are passed on. Internationally renowned as leaders of genetic investigation in epilepsy, they became the bridge between the work of William Lennox, a pioneer in the use of EEG in epilepsy, and the present surge of genetic epilepsy research. In the early 1980s, Dr. Bernard Rosenblatt started the first Evoked Potential lab, using EEG with computer averaging to stimulate different modalities like vision and hearing. These cutting-edge techniques allowed for diagnostics previously thought impossible, such as measuring hearing in a newborn baby. Along with Dr. John Guttmann, he developed one of the first seizure detection neonatal intensive care units. In 1985, the MCH Department of Clinical Neurophysiology was one the first centres to begin using Somatosensory Evoked Potentials (SEP) in monitoring orthopaedic spinal procedures.

Dr. Michael Shevell, who is the former director of the division, is now the Chair of the Pediatrics Department at the McGill Faculty of Medicine and Pediatrician-in-Chief at the Montreal Children’s Hospital and the McGill University Health Centre (MUHC).

Today, our division has a reputation both provincially and nationally for treating complex neurological disorders in children, and more specifically for our expertise in evaluating and treating intractable epilepsy, cerebral palsy and genetic disorders, as well as multiple sclerosis, stroke, neuro-inflammatory conditions, and neuro-oncologic disorders of the nervous system among other conditions.

Over the years, the division has received international recognition for its commitment to basic, clinical, epidemiological and qualitative research.

The Division of Pediatric Neurology of the Montreal Children’s Hospital is made up of ten pediatric neurologists, many of whom conduct research into a variety of complex neurological disorders.

The division also has two part-time nurses on staff and also includes a physiatrist, a social worker, and research associates Dr. Annette Majnemer and Dr. Marie Brossard-Racine.

Department head:

Dr. Guillaume Sébire, Director

Research Associates:

• Dr. Geneviève Bernard, pediatric neurologist
• Dr. Aparna Suvrathan, Research Associate

Staff members:

• Heather Davies, Advanced practice nurse
• Dr. Marie-Emmanuelle Dilenge, pediatric neurologist
• Dr. Gaetan Filion, physiatrist
• Dr. Michèle Larose, Psychiatry Liaison, pediatric neurologist 
• Dr. Geneviève Legault, pediatric neurologist, Residency Program Co-Director
• Dr. Kenneth Myers, pediatric neurologist, Associate Director of the Child Neurology Division Neurodiagnostic Laboratory
• Dr. Maryam Oskoui, pediatric neurologist
• Dr. Chantal Poulin, pediatric neurologist
• Sanaz Shadvar, nurse clinician
• Dr. Michael Shevell, pediatric neurologist
• Dr. Elisabeth Simard-Tremblay, pediatric neurologist, Residency Program Co-Director
• Dr. Myriam Srour, Residency Program Director
• Annie Remillard, chief technician, neurophysiology 

The Division of Pediatric Neurology of the Montreal Children’s Hospital receives many requests for inpatient consultation and we see patients in the hospital’s medical and surgical wards, intensive care units and emergency department on a regular basis.

We also care for a significant number of patients in our clinics. These are patients who have been referred by health professionals from the community. The majority of clinic visits are held in the A2 South or Brain-Development-Behavior (A3) outpatient clinic area of the hospital. We hold our clinics daily (Monday to Friday) in the afternoon. We sometimes request that patients undergo certain tests before coming to the clinic for the first time. Occasionally, a patient’s first visit may simply entail doing a physical examination and taking a detailed medical history of the child’s symptoms through discussions with the family.

After the child’s first visit to clinic, and if need be, we will arrange for tests such as an EEG in the B2 neurodiagnostic area  (an electroencephalography, or recording of electrical activity along the scalp), blood tests or imaging studies such as an MRI (magnetic resonance imaging). 

The Division of Pediatric Neurology of the Montreal Children’s Hospital provides care for children with challenging and complex neurological conditions.

We provide inpatient consultation on a 24/7 basis to all areas of the hospital including the medical and surgical wards, intensive care units and emergency department. We also provide consultation in a clinic setting to patients who are referred to us for the following categories of neurological illness: epilepsy or convulsive disorders that are not related to fever; neurodevelopmental disabilities (i.e. global developmental delay, intellectual disability, cerebral palsy, developmental language impairment), neuromuscular disorders, headaches that are resistant to treatment, complex movement disorders, neurogenetic, neurometabolic and neurocutaneous disorders, demyelinating disorders, multiple sclerosis, stroke, neuroinflammatory diseases, neuro-oncologic conditions, and high-risk survivors of the Neonatal Intensive Care Unit (NICU) and Pediatric Intensive Care Unit (PICU).

Our Division has implemented a screening process for consultations and follow-up of children requiring neurological intervention. While we treat children with any of the conditions listed above, we do not offer consultation or treatment for the following categories of referrals: children with routine headache who have not received a course of migraine prophylaxis; behavioural disorders (i.e. oppositional defiance disorder, conduct disorder, episodic dyscontrol syndrome); school related problems (i.e. ADHD, learning disabilities); patients with tics or Tourette's Syndrome already receiving medication intervention; autistic spectrum disorders without neurological co-morbidity; febrile seizures, both typical and atypical; and syncope.

Please note that requests for appointments in Neurology are given after they have undergone a triage process, which can take about 4 weeks:

• If accepted, the referral is entered on our waiting list.   The patient is not contacted until we have an opening in a clinic or in one of our associated facilities.
• If a referral does not meet the hospital’s referral criteria, the referral is returned to the referring physician with instructions. We note when the referral was returned and indicate why in our records.

If you have requested an appointment via our website, please be mindful of the above triage process. If you have questions about the status of your referral, please note that a status update can only be provided once this triage process has been completed, which may take about 4 weeks. Thank you.

Children visit the Neurophysiology laboratory for extensive testing and monitoring of symptoms related to seizures, paroxysmal disorders, or neuromuscular diseases. The Montreal Children’s Hospital Neurophysiology team provides a full range of investigative services in electroencephalography, evoked potentials and electromyography.  Our team is proud to be part of one of the best epilepsy surgery program in the province, saving lives and successfully saving children previously thought to be inoperable.

One of the Neurophysiology department’s major responsibilities is evaluation for possible epilepsy. Our team members who establish a child’s eligiblity for the epilepsy surgery program assesses intractable epilepsy in which a child does not respond to three or more medications.

An electroencephalogram (EEG) measures the electrical patterns in the brain. The EEG lab staff research children with paroxysmal disorders such as epilepsy or seizures. EEG recordings may be performed to gain information in the case of metabolic disorders, asphyxia, and pediatric brain trauma, or in post-surgical cases.

Electromyography (EMG) is the evaluation and recording of electrical activity produced by skeletal muscles. The EMG lab staff provide analysis of neuromuscular diseases in children. The department also offers monitoring services for the departments of Neurosurgery and Orthopedics.

An evoked potential is the electrical response of the brain to a sensory stimulus. This procedure is performed on a child to see how they react to a certain situation when the stimulus is brought on in a controlled medical environment. An EEG or EMG might be used to measure the levels of activity during an evoked potential test. 

Electrocorticography (ECoG), or intracranial EEG (iEEG), is the use of electrodes placed directly on the exposed surface of the brain to record electrical activity from the cerebral cortex. ECoG may be performed either in the operating room during surgery (intraoperative ECoG) or outside the surgery room (extraoperative ECoG). In the case of surgery, this procedure is used to explore the functional anatomy of the brain, mapping speech areas and identifying the somatosensory and somatomotor cortex areas that would not be surgically removed.

Vagus Nerve Stimulation (VNS) is generally used to treat epilepsy when all other treatment options have been exhausted. Vagus nerve stimulation is also a treatment for depression, and it is being studied for conditions such as multiple sclerosis, migraine and Alzheimer's disease.

Learn more about Dr. Sébire's lab