Multi-disciplinary Management Program of Paediatric

Refractory Epilepsy in NTWC - A Holistic Longitudinal

Care from Hospital to Community: A Clinical Audit of

Seizure, Cognitive and Psycho-behavioural Outcome

Dr Chak wai kwong Associate consultant Department of Paediatrics and Adolescent Medicine Tuen Mun Hospital NT West Cluster

Multi-disciplinary Management of Paediatric Refractory Epilepsy

Introduction: Paediatric Epilepsy is a heterogeneous disease with different

underlying etiologies; around 13 % of them are medical refractory. Patients do not only suffer from seizure, but also have

developmental, behavioural, psychological and cognitive problems. Epilepsy surgery and ketogenic diet have shown to be an effective

treatment alternatives. Objectives: To audit the seizure outcome of children and adolescence with

medical refractory epilepsy after epilepsy surgery and ketogenic diet from 2005 to 2012

To audit the cognitive and psycho-behavioural outcome after epilepsy surgery

Ketogenic diet

Psych-behavioural assessment Counseling

Medical Refractory Epilepsy

Epilepsy Surgery

Epileptogenic focus

MRI Video EEG

Ictal SPECT

PET

Neuro- psychological assessment

Multi-disciplinary case conference

Metabolic or Genetic Diagnosis

Specific Metabolic treatment

No specific focus

Optimize medical treatment

Clinical psychologist

Nuclear Medicine physician

Neurologist EEG technicians

Radiologist Neurosurgeon

Dietetic Physiotherapy Occupational assessment

Dietitians Physiotherapist Occupational therapist

Child psychiatrist Nursing Specialist Social Worker

Genetic or

Metabolic Diagnosis

Specific Metabolic treatment

Methodology:

Seizure Outcome of Epilepsy Surgery and Ketogenic Diet from 2005-2012

41%

32%

27%

Types of Epilepsy Surgery N=37

Temporal Lobe Surgery

Extra-temporal Lobe Surgery

Disconnection Surgery

50%

17%

25%

8%

Seizure outcome of Extra-temporal Lobe Surgery N= 12

Engel 1/Seizure free

Engel 2

Engel 3

Engel 4

73%

13%

7% 7%

Seizure outcome of Temporal Lobe Surgery N= 15

Engel 1/ Seizure free

Engel 2

Engel 3

Engel 4

80%

20%

Precentage of patient with Seizure Reduction on Ketogenic Diet N=10

Seizure reduction (Engel 1& 2)

No change

Cognitive and Psycho-behavioral Outcome after Epilepsy Surgery

-3

-2

-1

0

1

1 2 3 4 5 6 7

z-score

Patients

Right Temporal Lobe Surgery - Visual Memory

Pre-op Visual memory Post-op Visual memory

0

50

100

150

1 2 3 4 5 6 7

IQ score

Patients

Right Temporal Lobe Surgery - Full Scale IQ

Pre-op FSIQ Post-op FSIQ

0

50

100

150

1 2 3 4 5 6

IQ s

core

s

Patients

Left Temporal Lobe Surgery - Full Scale IQ

Pre-op FSIQ

Post-op

FSIQ

Conclusion:

• Epilepsy surgery and ketogenic diet are an effective treatment options in Paediatric Refractory Epilepsy

• Epilepsy surgery showed favorable cognitive and psycho-behavioual outcome

Acknowledgement

• Fong FTS, Yam KY, Ng CK, Department of Neurosurgery,TMH • Kwok Y, Sze WK, Psycho-behavioral Unit,TMH • Carmen Yeung, Sandra Shing, Dietetic Unit, TMH • Isabella Lee, Electro-diagnostic Unit, TMH • Rosita Yip, Occupational therapy Department, TMH • Nerita Chan, Physiotherapy Department, TMH • Lam SM, Tin NW, Department of Psychiatry, CPH • YC Wong, KM Ma, Department of Radiology, TMH • LH Yip, Alice Chau, Lee WC, Karen Kwong, Lam SY, NS

Kwong, Department of Paediatrics and Adolescent Medicine, TMH

• Chloe Mak, Carol Siu, Department of Pathology, PMH