Neurology

Child Neurology Service

Marisel Vazquez, MD
Professor
Section Chair
Department of Pediatrics
School of Medicine
University of Puerto Rico
Tel – 787-756-4020

Email –  marisel.vazquez1@upr.edu

Clinical Services

The Child Neurology Section is committed to provide care to diverse neurologic conditions: Epilepsy, CNS infections, Brain tumors, Headaches, Neonatal Neurologic complications, Demyelinating disorders, Degenerative disorders, Autism, Developmental delay, ADHD , and others (see below).  We provide inpatient and outpatient consultation in the University Pediatric Hospital and at the Intramural Private Practice Plan of the School of Medicine of the University of Puerto Rico.

Conditions treated include:

• Attention Deficit Disorders
• Autism
• Brain Deformations
• Cerebral Palsy
• Developmental Delays
• Disorder of Metabolism
• Epilepsy
• Fetal/neonatal neurology
• Headache/Migraine
• Learning disorders
• Motor delays
• Muscular dystrophy
• Movement disorders
• Multiple sclerosis
• Neuromuscular disorders
• Neurogenetic disorders
• Sleep disorders
• Spinal muscular atrophy
• Stroke
• Tics
• Tuberous sclerosis

Inpatient: Inpatients services are provided at the University Pediatric Hospital that is the main tertiary center of P.R.

Outpatient: There are three main clinic services:

Pediatric epilepsy clinic- specialized clinic of complicated pediatric patients with epilepsy between the ages of 6 to 21 years:

Faculty: Dr. Miriam Rios Motta- Epileptologist

Location: University Pediatric Hospital-3rd floor- clinic area

Day: Mondays AM

Phone: 787-777-3535 (7286)

For appointments: Referral is required for 1st appointment.

Pediatric Neurology Clinic

Faculty -Dr. Maria E. Dávila

Location: Medical Science Campus- Intramural Practice –“Reparto Metropolitano” -2nd floor –Pediatric area

Day:  Tuesday AM

Phone: 787-758-7910 (extension 234,226)

Contact: Clinic secretary

Referral is required for 1st appointment

Child Neurology Continuity Clinic

Faculty: All Child Neurology Faculty and residents

Location: Medical Science Campus- Intramural Practice –“Reparto Metropolitano” -2nd floor –Pediatric area

Day: Thursday AM

Phone: 787-758-7910 (extension 234, 226)

Contact: Clinic secretary

Referral is required for 1st appointment

Child Neurology Section Research Program

Marisel Vazquez, MD
Assistant  Professor
Section Chair
Department of Pediatrics
School of Medicine
University of Puerto Rico
Tel – 787-756-4020

Email –  marisel.vazquez1@upr.edu

Research Activities:

Marisel Vázquez, M.D.

Academic Rank: Assistant Professor,
School of Medicine,
University of Puerto Rico
Administrative title – Neurology Section and Program Director

Office Address:

Hospital Dr. Antonio Ortiz
Pediatric Department,
Call Box 191079, San  Juan, PR 00919-1079
Phone: 787-756-4020

Email: marisel.vazquez1@upr.edu

Research interest:

Neonatal Neurology , Neonatal seizures , Infantile Spasm, Autism

Research in progress; 

• 2011-present .Treatment Response and Neurodevelopmental Outcome in Patients with Infantile Spasms . Vazquez M, Gonzalez J.

• 2007-present. HIV/AIDS Cohort Study (PHACS)  Surveillance Monitoring for ART Toxicities Studies in HIV uninfected children Born to HIV infected Mothers (SMARTT Study). Position; Neurology Consultant. Source of funding; Sponsor by National Institute of Child Health and Development. (SJH 2007-2010) (RCM 2011-present)

Research Projects Participation

• 2007-present. HIV/AIDS Cohort Study (PHACS)  Surveillance Monitoring for ART Toxicities Studies in HIV uninfected children Born to HIV infected Mothers (SMARTT Study). Position; Neurology Consultant. Source of funding; Sponsor by National Institute of Child Health and Development. (SJH 2007-2010) (RCM 2011-present)

• 03/2006-03/2007 An Open-label multicentric study of the long-term safety of Depakote sprinkle capsules in the treatment of partial seizures in children, Multicentric/local PI, San Juan City Hospital

• 2005-2007. Grant HRSA : For the development of Child Neurology Training Program in P.R. Position: Clinical Investigator (PI Dra. Gregory Health Department) .Source of funding; HRSA

• 1992-2002.Prospective Study Federal Grant“Early Intenvention in Neonatal Seizures” HSJ .Funding Grant; “Consejo Estatal de Deficiencies en el Desarrollo”
• 2002-2004.Profile of learning Disability in Adolescents with Juvenile Delincuency Problems”- PI: Dr.Linares RCM. M Vazquez ;Consultant, evaluator  and Development  of the Neurology protocol.Funding; Federal Educational Dpt.
• 2004-2005.Preschool detection of risk for Learning disability .-PI; Dr. Linares –RCM. -Participation; Child Neurology Consultant ; Development of Neurology protocol and evaluator Funding; Federal Educational Dpt Grant .
• 1993-1999. “Neurologic manifestations of Puertorrican Pediatric patients with HIV” .Medical Student Investigational Study during Summer rotation.  Fraga I, Vazquez M. -Prize; Ramon Ruiz Arnau to Ivonne Fraga Medical School  prize. class 1995

Presentations:

• 40Th Child Neurology Society Annual Meeting, Savannah Georgia. October 27, 2011. No Association between C677T MTHFR gene polymorphism and Autism Spectrum Disorders among children in Puerto Rico. Montalvo-Ortiz Jocelyn,Collazo Madeline,Echegaray Marcos,Oliveras Rentas Rafael,Deliz Laura,Vazquez Correa Marisel,Carlo Simon,NEgroni Xamayta,Hernandez Yanira, Acevedo Summer
• XX Annual Research and Educational Forum –UPR School of Medicine 2011.Poster; Descriptive Study of prenatal and perinatal events and their association with the development of autistic spectrum disorders at a child Neurology Clinic in Puerto Rico.  Rios J, Vazquez M, San Miguel L.
• XXIX Annual Research and Educational Forum-UPR School of Medicine -2010. Infantile Spasms: Case Series Review; Gonzalez J ,Vazquez M. Poster  .J. González M.D., and M. Vázquez

• XXIX Annual Research and Education Forum– UPR School of Medicine–2009  Poster:  Developmental Study on a Pediatric Cohort Diagnosed with neonatal seizures ; General Intelligence and Visuo-motor Function. Protocol#A2770107. San Miguel-Montes L, Vazquez M.

• XXVIII Annual Research and Education Forum– UPR School of Medicine–2008  Poster:  Clinical and Cognitive Profile of Puerto Rican Pediatric Patients: A Pilot Study. Ríos-Motta, M., San Miguel-Montes, L., Avilés, R., Duprey A., Ríos, J., Vázquez, M.

• XXVIII Annual Research and Education Forum– UPR School of Medicine–2008 Poster; The educational And community impact of the development of a new Child Neurology Program in Puerto Rico.  Gonzalez B., Vazquez M. (2nd prize)

Publications:

• San Miguel-Montes, L., Avilés, R., Duprey A., Ríos, J., Vázquez, M.  Clinical and Cognitive Profile of Puerto Rican Pediatric Patients: A Pilot Study. Ríos-Motta, M., PRHSJ Vol. 27 No. 3, p.282, September, 2008.
• B Gonzalez, M Vazquez. The educational And community impact of the development of a new Child Neurology Program in Puerto Rico .PRHSJ Vol. 27 No. 3,  September, 2008.
• Isenberg, Vázquez. Are the pupil of the premature infant affected by Intraventricular hemorrhage?       Journal of Child Neurology Vol 9 Num 4 440-442 , October 1994
• Isenberg Molarte, Vázquez .The fixed and dilated pupil of the premature neonate. Am Journal of Opthalmology 110; 168-171. August 1990.
• Fernandez Sein, Vázquez Correa.  Hypokalemic Periodic Paralysis: A rarely considered diagnosis in the Pediatric Patient  PR Medical Association Bulletin Vol7 Num2  1985
• Vazquez Calzada, Vázquez Correa. Cuidado Prenatal en Puerto Rico .Revista Salud Publica.Vol 4 1982-1983

María Dávila, M.D.

Academic Rank:

Assistant Professor,

School of Medicine,
University of Puerto Rico
Administrative title: Associate Program Director

Office Address:

Hospital Dr. Antonio Ortiz
Pediatric Department,
Call Box 191079,
San Juan, PR 00919-1079
Phone: 787-756-4020

Email: maria.davila6@upr.edu

Research interest: CNS Demyelinating Disorders in children

Research in progress:

“The clinical and prognostic factors for relapse after acute disseminated encephalomyelitis in children”

Research Projects Participation:

• 03/2006-03/2007   An Open-label multicentric study of the long-term safety of Depakote sprinkle capsules in the treatment of partial seizures in children, Co-investigator, San Juan City Hospital
• 2005-2007. Grant HRSA : For the development of Child Neurology Training Program in P.R. Position: Clinical Investigator (PI Dra. Gregory Health Department) .Source of funding; HRSA

Presentations:

• XXVII-Annual Forum Research and Educational Forum– UPR School of Medicine.  March 12-14, 2008. Poster:  Acute and Disseminated Encephalomyelitis: A Case series Report at the University Pediatric Hospital in Puerto Rico. M Davila, K Cruz, R Alvarado, B Gonzalez.
  • • XXX Annual Research and Education Forum- UPR School of Medicine March 2010 Poster:  First Unprovoked Seizure: Correlation between Clinical Presentation and Findings on Brain MRI and EEG. B. González, MD; J.González, MD; M. Ríos, MD and M. Dávila, M.D.

• • • XXXI Annual Research and Education Forum- UPR School of Medicine May 2011  Poster: Treatment with Intensive Intravenous Immunoglobulin in Recurrent and Multiphasic Forms of Acute Disseminated Encephalomyelitis: Case Reports at the University Pediatric Hospital in Puerto Rico.  J González MD, and  M Dávila MD

Publications:

• • • González, B., González, J., Ríos, M., and Dávila, M. First Unprovoked Seizure: Correlation between Clinical Presentation and Findings on Brain MRI and EEG. PRHSJ Vol. 29 No. 2, June, 2010, p.166

Miriam E. Ríos, M.D.

Academic Rank: Assistant Professor,
School of Medicine,
University of Puerto Rico

Administrative Title: Director- Pediatric Epilepsy Clinic

Office Address:

Hospital Dr. Antonio Ortiz
Pediatric Department,
Call Box 191079,
San  Juan, PR 00919-1079
Phone: 787-756-4020

Email: miriam.rios@upr.edu

Research interest:

Epilepsy and EEG in children; Cognitive and psychiatric co-morbidities in children with epilepsy

Research in progress

New antiepileptic drug clinical trial

Presentations:

• • • American Epilepsy Society Annual Meeting, San Francisco, CA, December 1996.  Cortical stimulation mapping of right hemisphere language in patients with bilateral speech arrest during the intracarotid amobarbital procedure.  Ríos, M.; Hart, J.; Gordon, B.; Lesser, R.P.

• • • XXVIII Annual Research and Education Forum- UPR School of Medicine–2008 Poster:  Clinical and Cognitive Profile of Puerto Rican Pediatric Patients: A Pilot Study. Ríos-Motta, M., San Miguel-Montes, L., Avilés, R., Duprey A., Ríos, J.

• • • American Epilepsy Society Annual Meeting, Boston, MA, December 2009   Poster presentation: Depressive Symptoms in Adolescents with Epilepsy Attending the Epilepsy Clinic of the University Pediatric Hospital in Puerto Rico.  M Salcedo MD, M Ríos MD.
    • XXX Annual Research and Education Forum – UPR School of Medicine-March 2010 Poster: Prevalencia de síntomas de esquizofrenia en pacientes de una clínica de epilepsia en Puerto Rico. C. Morales-Rodríguez, R. Rios Motta, M. Ríos-Motta.  Escuela de Salud Pública, UPR-Recinto de Ciencias Médicas.

• • • XXX Annual Research and Education Forum- UPR School of Medicine March 2010 Poster: First Unprovoked Seizure: Correlation between Clinical Presentation and Findings on Brain MRI and EEG. B. González, MD; J.González, MD; M. Ríos, MD and M. Dávila.

Publications:

• • • Ríos, M.; Lenz, F.; Lesser, R.P.; Chau, D.; Laser evoked potentials recorded from the human cingulate cortex, (abstract); Proceedings of the 8th World Congress on Pain, pp. 441, 1996.
    • Ríos, M.; Hart, J.; Gordon, B.; Lesser, R.P., Cortical stimulation mapping of right hemisphere language in patients with bilateral speech arrest during the intracarotid amobarbital procedure,(abstract); Epilepsia, Vol. 37, suppl. 5, pp. 132, 1996.
    • Lenz, F.A. , Ríos, M. , Zirh, A. , Chau, D. , Krauss, G. , Lesser, R.P.  Painful stimuli evoked potentials recorded over the human anterior cingulate Gyrus.  Journal of Neurophysiology, 79:2231-2234, 1998.
    • Lenz, F.A. , Ríos, M., Chau, D., Krauss, G., Zirh, A., and Lesser, R.P.  Painful stimuli evoke potentials recorded over the parasylvian cortex in humans.   Journal of Neurophysiology, 80:2077-2088, 1998.
    • Ríos M. , Treede R.D., Lee J.-I., and Lenz, F.A.  Direct evidence of nociceptive input to human anterior cingulate gyrus and parasylvian cortex.  Current Review of Pain, 3:256-264, 1999.
    • Treede, R.D., Vogel, H., Ríos, M., Krauss, G., Lesser, R.P., Lenz, F.A. Pain-related evoked potentials from parasylvian cortex in humans.  Functional Neuroscience: Evoked Potentials and Magnetic Fields (EEG Suppl. 49): 250-254, 1999.
    • Lenz, F.A., Krauss, G. , Treede R.D. , Lee, J.-I. , Boatman, D. , Crone, N., Minahan, R. , Port, J. , Ríos, M.  Different generators in human temporal-parasylvian cortex account for subdural laser-evoked potentials, auditory-evoked potentials, and event-related potentials.  Neuroscience Letters 279:153-1156, 2000.
    • Lugo González, ME; Santos Ortiz, MC; Dávila Torres, RR; Ríos Motta, M.  Aspectos Relacionados al cumplimiento de medicamentos en un grupo de encargados de niños y adolescentes con epilepsia.  P R Health Sci J (Puerto Rico) Vol. 20 (3), p257-67; Sep. 2001.

• • • San Miguel-Montes, L., Avilés, R., Duprey A., Ríos, J., Vázquez, M.  Clinical and Cognitive Profile of Puerto Rican Pediatric Patients: A Pilot Study. Ríos-Motta, M., PRHSJ Vol. 27 No. 3, p.282, September, 2008.
    • Salcedo, M., Ríos, M.   Depressive Symptoms in Adolescents with Epilepsy Attending the Epilepsy Clinic of the University Pediatric Hospital in Puerto Rico. Epilepsia, 50(Suppl. 11): p. 232, 2009
    • Morales-Rodríguez, C., Rios Motta, R., Ríos-Motta, M.  Prevalencia de síntomas de esquizofrenia en pacientes de una clínica de epilepsia en Puerto Rico; PRHSJ Vol. 29 No. 2, June, 2010, p.162.
    • González, B., González, J., Ríos, M., and Dávila, M. First Unprovoked Seizure: Correlation between Clinical Presentation and Findings on Brain MRI and EEG. PRHSJ Vol. 29 No. 2, June, 2010, p.166

.

Child Neurology Section

Marisel Vazquez, MD
Professor
Section Chair
Department of Pediatrics
School of Medicine
University of Puerto Rico
Tel – 787-756-4020

Email –  marisel.vazquez1@upr.edu

Fellowship Academic Curriculum

Three-year pediatric neurology training program:

• One year on the adult neurology rotations (Adult Neurology Residency Program) (hospital-based).  Clinical services are provided in two different medical facilities (University District Hospital, and Veterans Administration Hospital).This include exposure to stroke, movement and neuromuscular rotations. The adult neurology training is distributed throughout the first 2 years and is divided between consultative and ward services.
• One years of child neurology (hospital-based- University Pediatric Hospital and San Juan City Hospital)
• 12 month selectives and elective time-
  • Selectives;1 month  Neurophysiology (EEG-EP), 1month Neuroradiology, I month Child psychiatry,2 months in Basic Neuroscience course
  • Electives;  Neurosurgery, Genetics, Pediatric Rehabilitation Medicine, Pediatric Epilepsy, Neuroradiology, other
• Conferences, lectures, courses and seminars are designed to keep Residents informed of major developments in both the basic and clinical neurosciences.  These are available through the Department of Neurology, Pediatrics, Neurosurgery, and Psychiatry.  Didactic activities include regular discussion of a wide variety of topics, such as seizures, cerebrovascular disease, neonatal neurologic complications, developmental disorders, movement disorders, neuromuscular disorders, cognitive neurology, neuropathology (clinical-pathological conference), pediatric oncology, and neuroradiology, among many others.
• Residents are required to participate in at least one clinical or basic research project during their training under the mentorship of a member of the faculty and are encouraged to publish the results in peer-reviewed journals.
• Residents are mentored and encouraged to present their projects at scientific meetings.
• RITE written exam is required each year

At the end of the training candidates will be qualified to sit for the examination of the American Board of Psychiatry and Neurology for certification in Neurology with special qualifications in Child Neurology and be prepared for the independent practice of child neurology.

Life as a fellow

Residents work alongside skilled and experienced professionals, committed to caring for their patients. The Pediatric Neurology resident, along with the attending staff, is responsible for managing the primary inpatient and hospital consultations in the general ward, and Intensive care units (Adult, Neonatal, and Pediatric).  During the daily rounds the residents discuss their clinical findings, assessment and management to the attending faculty, basing them on the literature search and other sources.  Inpatient admissions are followed and co-managed by pediatric residents. The inpatient team is composed of a pediatric neurology attending physician, 1 pediatric neurology resident, 1 junior or senior resident from adult neurology and at least 1 pediatric resident.  Often there are also Child Psychiatry residents and visiting UPR medical students. Clinics are held weekly in both Pediatric and Adult Neurology.  In addition, all pediatric neurology residents have a weekly continuity clinic, staffed by a faculty member, which they attend year-round for all three years of the residency.  Didactic instruction includes conferences twice a week covering neuroscience and clinical topics, a monthly journal club, neuropathology and brain cutting sessions, a weekly book review session, and one-on-one teaching at the bedside. The senior resident assists our faculty in the supervision of child neurology residents in lower levels of training through direct supervision and has a supervisory role as Chief Resident in third year. Calls from home average every 3rd to 4th day.  The resident must take the RITE written exam each year.

Life after fellowship

Pediatric neurologists have a high demand in the island community.  There is a shortage of these specialists and opportunities for independent and /or hospital based practice are always available.  Our graduates have started their own practice, or have joined very busy practices in different hospitals around the island; one of them practice in USA, others have stayed here at the University Pediatric Hospital and remained on faculty.

How to apply

A. Appointment of Residents 

The admission requirements for the Child Neurology Residency Training Program are:

• Graduated from an LCME Accredited Medical School
  • Evidence of successful completion of USMLE Part 1, 2 and 3
  • Graduated from foreign Medical School
  • Certified evidence of completion of Medical School Graduation
  • Certificate of the ECFMG examination.
  • Foreign graduates not US citizens must present an official certificate of their Medical School   Diploma provided  by the corresponding Embassy and a certificate of the Federal Office of Immigration and Naturalization (PL 94-488)
  • Fully bilingual, dominating well English and Spanish

• Prerequisite Training: the training can be initiated following one of three options:
  • Two years of postgraduate training in an approved pediatric program
  • Tne PGY-1 year (as described in the ACGME Program Requirements for Residency Education in Neurology, Section I.A.1) and 1 year of residency training in pediatrics
  • Tne year of pediatrics plus 1 year of basic neuroscience training. The program director must review and determine the acceptability of these initial 2 years of training.

The program director must review and determine the acceptability of these initial 2 years of training.

B.  Procedure for evaluation of selection of candidates: 

There is an admission and Selection Committee composed of Child Neurology and Adult Neurology faculty members representing each of the participating Institutions.  The selection process is in accordance with the institutional and departmental policies and procedures.

Candidates must:

• Complete an application form
• Submit transcripts from Undergraduate College and Medical School
• Dean’s letter
• Results of approved USMLE (1, 2, 3) or ECFMG Certificate
• Two letters of recommendation from faculty members of his/her Pediatric Residency Training Program or Neurology Training Program
• Letter of recommendation from the current Residency Program Director

The committee interviews the candidates individually and reviews all the submitted documents. The eligible applicants are evaluated on the basis of their academic credentials, aptitude, personal characteristics and ability to communicate effectively.  The committee selects candidates in a ranking order.

Contact: Ms. Leticia Rodríguez- Neurology Section Coordinator

e-mail:leticia.rodriguez2@upr.edu