Authors (including presenting author) :
Cheng WW(1), Chan Yung(2), Wong HT(2), Wu Peter(2), Ko Natalie(2), Ma Tracy(2),
Ko PW(1)
Affiliation :
(1) Department of Paediatrics and Adolescent Medicine, Caritas Medical Centre
(2) Department of Neurosurgery, Kwong Wah Hospital
Introduction :
Epilepsy is a common neurological disease. Despite the advent of new anticonvulsants, many patients remain intractable. Epilepsy surgery offers them a glimpse of hope.
Objectives :
The establishment of Epilepsy Surgery Service in KWC aims to provide surgical cure to selected patients, to improve their seizure control and quality of life.
Methodology :
The inception of the service in 2016 starts with some essential components: long term EEG monitoring, 3T MRI, electrocortiocography, and a dedicated team composed of epileptologist, neurosurgeon, neuropsychologist and intra-operative monitoring scientist. Over the years, with the advanced technology of PET, SPECT, neuro-navigation, prolonged electrocorticography monitoring, and cortical mapping, seizure foci are better delineated. We are able to operate on complex cases precisely and safely.
Result & Outcome :
Since 2016, a dozen of intractable epilepsy paediatric patients has been worked up in KWC. Six patients received epilepsy surgery. All have favourable outcomes.
Case 1:
A girl with bilateral mesial temporal sclerosis had convulsion since she was seven years old. She had repeated head injuries from seizures. After right anterior temporal lobectomy and amydalo-hippocampectomy at twenty-two years old, she successfully weaned off all anticonvulsants. She has been seizure free since operation in 2016. She enjoys normal life and set up an arts studio.
Case 2:
A girl presented with convulsion since she was eleven years old. Her seizure semiology were attacks of bizarre behaviour, and was misdiagnosed to have psychiatric problem. Her academic performance deteriorated and had multiple hospital admissions from seizures. She received epilepsy surgery at seventeen years old. Although currently she is still on anticonvulsants, she has no major seizures. Additionally, there is ongoing improvement in her cognitive functioning.
Other cases:
Two children are rendered seizure free after epilepsy surgery, both were done at thirteen years old. Another girl with seizure onset at three years old, received surgery at twenty years old. Besides a 50% reduction in seizure frequency, she could enjoy a lot of leisure activities and resume some schooling which she had missed for years. The last patient has infrequent focal seizures after surgery and never has head injuries after surgery at nineteen years old.
Conclusion:
The Epilepsy Surgery Service in KWC has helped a group of patients to abort seizure or to attain better seizure control. After epilepsy surgery, patients are able to have more life participation, and indeed turn a new chapter of life.
