Neurosciences Department

Borthwick Ward is on Level 3 of the Royal Hospital for Children and Young People (RHCYP) in Edinburgh. We look after babies, children and young people with conditions affecting their brain, nervous system or spinal cord, caring for patients before and after surgery, patients who need to stay on the ward (including those recovering from illness or injury), as well as children and young people coming for special tests or investigations for conditions such as epilepsy. We are home to the Scottish Paediatric Epilepsy Surgery Service. Our Neurophysiology department can also be found next to Borthwick Ward, for children coming for tests or investigations like an EEG. Nurse in charge: Louise Harrington

We look after patients with a range of conditions, including:

• General Neurology (those needing specialists and the diagnosis of complex neurological conditions or problems). Examples might include severe headaches, Meningitis, Encephalitis, or Tic disorders.
• Epilepsy Opens in new window
• Motor disorders including Cerebral Palsy
• Neuromuscular Service
• Brain Injury
• Congenital Brain Malformation (including Spinal Bifida)
• Rare diseases including Neuroinflammatory Disorders and Narcolepsy

Epilepsy is a condition that affects the normal electrical activity our brains use to communicate with the rest of our body.  A seizure happens when there is a sudden burst of intense electrical activity in the brain. This causes a temporary disruption to the way the brain normally works, so the brain’s messages become mixed up or scrambled. A seizure could cause your body to move involuntarily, have altered sensation, have altered behaviour or a change in the level of awareness.  Infants and children can sometimes have a one-off seizure, and this does not mean they have epilepsy.  Epilepsy is diagnosed if you have recurrent seizures, and a specialist doctor reviews the history of events and the results of some tests. Epilepsy can start at any age, and there are many different epilepsies. Some epilepsies last only for a limited time, with the seizures stopping never to return, but for some children and young people, epilepsy is a life-long condition. Find out more about Epilepsy. Opens in new window

The Scottish Paediatric Epilepsy Surgery Service (SPESS) is a specialist team made up of experts from across Scotland, who all help decide if surgery could benefit children with epilepsy. The team is described as a ‘multi-disciplinary team’ which means many different people working together, including the epilepsy surgery team based in Edinburgh and consultant paediatric neurologists, epilepsy nurse specialists, neurophysiologists, radiologists, psychologists, occupational therapists and physiotherapists from around the country. The epilepsy surgery team works with each child’s local team and the specialists looking after children at the Tayside Children’s Hospital in Dundee and the Royal Hospital for Children in Glasgow.  Our patients can come from all over Scotland, but we try to treat young people as close to home as possible, both before and after any surgery. The national epilepsy surgery centre is at the Royal Hospital for Children and Young People in Edinburgh, where all operations occur. Find out more about Epilepsy Surgery Opens in new window .

Paediatric neurosurgery provides comprehensive state of the art care for children with brain and spine conditions. Our paediatric neuroscience department offers unique integrated care that involves different specialists from neurology, neurophysiology, neurorehabilitation, neuropsychology, oncology, neuroradiology. We use high-tech equipment to diagnose children and teens and to perform advanced surgeries. These include endoscopic surgery, intraoperative MRI, robotic surgery for epilepsy, stereotactic computer-assisted navigation during surgery and others.

The national Epilepsy Surgery Service also operates out of this department, treating children and young people from across Scotland.

Conditions that we treat

• Brain and spinal tumours (intraoperative MRI)
• Head and spinal traumas
• Drug-resistant epilepsy surgery (Epilepsy Surgery Service)
• Intra-cranial infections requiring surgery
• Chiari malformations
• Neuro-vascular conditions including ischemias (brain bypass)
• Hydrocephalus and CSF circulation disorders
• Spina bifida, complex dysraphisms and spinal lipomas
• Simple craniofacial abnormalities – craniosynostosis
• Spasticity (Baclofen pump implants, Selective Dorsal rhizotomy)

The Neurophysiology team of Clinical Physiologists specialises in tests to diagnose and monitor epilepsy, head injuries and other brain conditions or nerve disorders. We help patients from newborn babies to young people up to 16 years old.

What we do

We perform diagnostic tests to understand how a patient’s brain and nerves are working and decide what they need.  Tests examine the electrical brain waves, known as Electroencephalogram (EEG), and electrical tests look at how nerves and muscles are working, known as Nerve Conduction Studies (NCS) and Evoked Potentials (EP).

Tests and Checks

Electroencephalogram (EEG)

A routine EEG is painless and records the electrical impulses made by the brain. A gel is used to clean the skin, and then small discs, called electrodes, are placed on the head with a sticky paste.  A recording of the brain wave activity is then taken. During the test, patients may be asked to perform some deep breathing exercise or look at a flashing light at different speeds.  This test might last up to 1h30 minutes.   The only preparation required is to have clean hair with no gel and to have eaten before the test.  Find out more about the test here: https://youtu.be/TNifQCrluo4

Sleep-deprived EEG

Like a routine EEG, this test requires a reduced amount of sleep (4-5hours) before the patient comes to the hospital. This test can last up to 2hours. Children will be asked to try to fall asleep.  This might not always be possible, but the effort is always appreciated!

Ambulatory EEG

An ambulatory EEG is a longer EEG, recorded while patients are at home. Like a routine EEG done at the hospital, a special putty is applied on top of the discs to help the electrodes stay longer. The leads are then tied together and connected to a recording box (in a bag or backpack) that can be worn over the shoulders. Setup is done at the hospital, after which patients can and try to do their normal routine as much as possible. (Showering is not be allowed). Children return after 24 hours so that all the information can be downloaded. In some cases, children might go home and continue the test for a further 24 hours. Once complete, the physiologist will remove all the electrodes and paste.

Video telemetry

Video telemetry EEG monitoring is performed as an inpatient at the hospital. This test's preparation is similar to an ambulatory EEG, but instead, children will be admitted to the neurology ward. The recording period can vary from one to five days, depending on the consultant decision.  Children will stay alongside a parent or carer in a single room that is equipped with video cameras. The patient will be advised not to leave the room during the monitoring period to minimize the time off-camera.  It is helpful to bring in favourite books and toys to help occupy the time.  Further information will be given to families coming in for this test.

Nerve conduction Studies

Nerve conduction studies (NCS) are used to test how well the nerves in the hands or feet are working. The preparation of this test only requires sticky electrodes on the skin and a stimulator. NCS is performed by applying small electrical impulses to the nerves and recording their responses.  This test might last 30-45minutes.

Evoked Potentials

Evoked potentials are diagnostic tests that study how well messages travel through different nerves to the brain. Electrodes will be attached to a patient’s head using a sticky paste, and on some occasions, sticky electrodes will be attached to other parts of the body. Depending on which test is being performed, patients may be asked to look at a screen or flashing lights, listen to a sound or receive small electrical impulses.  Tests will usually take around 30 minutes but may take longer in some cases.  The team is always happy to answer any questions and do their best to ease every child.

Trans-Cranial Magnetic Stimulation

Trans-Cranial Magnetic Stimulation studies the motor pathway that goes from the brain to the muscles of a person’s hands and legs. For this procedure, small stickers will be attached to the skin over the muscle to be studied. A magnetic coil will be placed on top of the patient’s head, corresponding to the area to be studied, and a magnetic impulse will be given. This will travel through the brain and then to the muscles. Responses will be recorded and analysed.  It does not hurt.  This test might last 30-45minutes.

Intraoperative Neurophysiology Monitoring (IONM)

Intra-operative monitoring is performed on patients undergoing spinal corrections or some neurosurgeries. The aim is to prevent and reduce nerve or brain damage during the surgery giving the surgeon an early warning or looking out.  When the patient is asleep under general anaesthesia before surgery, tiny needles and electrodes are attached to the patient’s head, hands and legs. The wires will be connected to a recording and monitoring system. During the surgery, the physiologists will be responsible for recording and analysing responses. If any changes are detected, the surgeon will be alerted on time.  If needed, pre-operative tests are performed in the neurophysiology department before surgery.

Invasive EEG Monitoring

Invasive monitoring is a very specialised and detailed procedure used to find the brain's exact area, causing seizures. This is usually performed in cases where medication is not enough to control seizures. Invasive monitoring involves an operation to place (EEG) electrodes, directly over the surface of the brain (called grids or strips electrodes) or into the brain itself (depth electrodes). These electrodes are then connected to an EEG monitor so that clinical physiologists can record brain activity over several days.  We understand that families will have questions and concerns about procedures like this and always make time to answer them.

Meet the Team

Our department is a diverse team of physiologists, neurology consultants and a secretary.   The team works in different areas for children, young people, adults and theatre.

Neurophysiology Team

Ruth Brotherstone - Service Manager (Neurophysiology)    Brian Jordan - Operational Lead, Epilepsy Invasive (Paediatrics) Jamie Macdonald - Operational Lead, Intra-operative Monitoring Katie Fisher - Operational Lead, Epilepsy Invasive (Adults) Lindsay Gripton - Education Coordinator Ciara Michaelson - Advanced Clinical Physiologist Andria Stylianou - Advanced Clinical Physiologist Celma Queza - Advanced Clinical Physiologist Gemma Schofield - Advanced Clinical Physiologist Jamie Crowther - Specialist Clinical Physiologist Sarah Rankin - Advanced Clinical Physiologist Francesca Bruschelli - Advanced Clinical Physiologist Natacia Hambakis - Trainee Specialist Clinical Physiologist Saiyma Munni - Trainee Specialist Clinical Physiologist

Our Consultants

Dr Ailsa McLellan – Consultant Neurologist Dr Jay Shetty - Consultant Neurologist Dr K. Kamath Tallur - Consultant Neurologist Dr Kenneth McWilliam - Consultant Neurologist

Department Secretary

Tracy Wilson

Contact Us

We are happy to answer enquiries relating to existing patients or scheduled appointments.  Contact us by phone on 0131 312 1506 (Monday-Friday, 8am-2pm). This number also has a voicemail service

Test results

Test results are always sent to the medical professionals first, who will contact families to discuss what happens next.  Please do not contact the neurophysiology department for test results as staff cannot give them directly to families. Thank you.

Child Brain Injury Trust Opens in new window Edinburgh Headway Opens in new window Epilepsy Scotland Opens in new window SBH Scotland Opens in new window Chiari Malformation Opens in new window Narcolepsy Opens in new window Capability Scotland Opens in new window Muscular Dystrophy Opens in new window Encephalitis Opens in new window Meningitis Association Scotland Opens in new window Multiple Sclerosis Trust Opens in new window Multiple Sclerosis Society Opens in new window Scottish Multiple Sclerosis Register Opens in new window