Abstracts

Rationale: The only cure for drug resistant epilepsy (DRE) is surgery. There is an 80% chance of achieving seizure freedom, plus the benefit of reducing psychosocial comorbidities. (Bowen et al., 2012). Surgical results have far better outcomes with respect to seizure freedom and improved quality of life than continued medical treatment. However, despite its effectiveness, surgery is underutilized, with only a fraction of the population who may be eligible for surgery assessed every year (CCSO Guidelines, 2016). A set of guidelines were launched by Critical Care Services of Ontario (CCSO) designating major referral hospitals as regional or district epilepsy centres depending on their ability to perform resective surgery. In 2008, Children's Hospital, London Health Sciences Centre was designated as one of the two paediatric epilepsy surgical centres in Ontario. In 2017, a multi-disciplinary Comprehensive Epilepsy Clinic (CEC) was created with the goal to improve the well-being and facilitate interventions for children with DRE. The aim of this study is to determine if a CEC improves access to surgical therapies for children with DRE. Methods: The CEC team includes: three pediatric epileptologists, an epilepsy nurse, a social worker, a community epilepsy educator, a neurosurgeon, a transition team, a medical geneticist, a neuropsychologist, a child life specialist, and a dietitian. A specialized referral process to the CEC for children with DRE and structural brain lesions come from health care providers in the community and members of the pediatric neurology division. These new consults are triaged to streamline advanced treatment options. We retrospectively reviewed the clinical database for the last five years and compared the number of surgeries performed 2.5 years before the CEC was launched vs. 2.5 post. We also gathered the growth of the clinic based on the following metrics: number of clinics per month, number of new referrals, and number of follow ups. Results: The study took place in the second largest surgical centre in Ontario. The total number of patients evaluated for surgery in the last five years from 2014-2019 was123; pre-CEC was 27 (22%) vs. 96 post (78%). Of those evaluated, 61 (50%) had surgical therapy; pre-CEC 15 (12%) vs. post 46 (37%). The CEC facilitated 26 Vagal Nerve Stimulator (VNS) implantations vs. 1 prior. The CEC has grown from 1 clinic per month in 2017 to 3 a month in 2019. With 25 new consults and 88 follow ups the first year to 58 new consults and 176 follow ups the second year. Overall, evaluations, surgeries, and CEC growth has more than tripled. Conclusions: A CEC model improves access to surgical therapies in children with DRE, with continued evaluation of potential candidates via a multi-disciplinary team by facilitating pre-surgical work up. We ascertain the success of this clinic model given the observed surgical growth in the last 2.5 years in specifically recruiting referrals for patients with DRE and/or structural brain lesions. Creating a simple but well-defined referral process that bridges the gap between front line provides (Pediatricians and Pediatric Neurologists) to specialized pediatric epilepsy care culminates in greater numbers of children with DRE evaluated for epilepsy surgery. Given the impact of this model in facilitating epilepsy surgical work ups for curative procedures, we encourage its replications in other epilepsy programs. Funding: No funding