multi-disciplinary management program of paediatric … · · 2013-05-24dietitians...
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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