Abstracts

Rationale: Patients with refractory epilepsy require multidisciplinary care with close collaboration between medical and surgical epilepsy specialists (i.e. pediatric epilepsy and pediatric neurosurgery). Traditionally, this care has been carried out serially, in separate office visits.  However, a multidisciplinary clinic may allow improved communication between the medical and surgical teams, and more efficient care delivery for children with epilepsy and their families.  We report a pilot joint pediatric neurosurgery epilepsy multidisciplinary clinic during which the patient is evaluated by the epilepsy and neurosurgery team in the same physical location during a single patient visit.  Methods: Starting in April 2017, we scheduled and staffed a joint pediatric neurosurgery epilepsy multidisciplinary clinic, which includes a pediatric epileptologist, pediatric neurosurgeon, pediatric clinical neurophysiology fellow, neurosurgery fellow, pediatric epilepsy nurse practitioner, neurosurgical physician assistant, ketogenic dietician, and social worker. The patient’s history, epilepsy course, imaging and any further testing are reviewed. A plan is outlined and then discussed with the family by the team.  Results: We saw a total of 18 patients over one year.  The session was scheduled roughly once to twice per month, and included 1 – 3 visits.  Of the 18, half (9) were subsequently referred for a neurosurgical procedure: 5 had resective surgery, 2 are scheduled for surgical resection, and 2 underwent VNS placement. 7 patients received other modalities of treatment and 2 patients were lost to follow-up. Six were deemed to be not surgical candidates at the time of the evaluation after further testing and two were lost to follow up.  For the surgical cases, surgery occurred 12 to 53 days after the first visit.  Post- operatively, we saw 3 patients for 2 follow-up visits. Conclusions: A multidisciplinary clinic is a feasible model of care.  In ongoing work, we are evaluating patient satisfaction, time to complete pre-surgical work-up, time to presentation at surgical conference, time to surgery, and postoperative epilepsy outcomes. In addition, this clinic offers the epilepsy fellow and neurosurgery fellow a unique opportunity to see difficult cases and learn to perform a surgical evaluation with a multidisciplinary team approach.  Funding: None