Abstracts

This abstract is a recipient of the Nurse and Advanced Practice Provider Travel Award

Rationale: Epilepsy surgery is the only cure for well-selected children with drug resistant focal epilepsy. When localization of the epileptogenic zone and/or lateralization is difficult, further diagnostic testing beyond magnetic resonance imaging (MRI), pediatric epilepsy monitoring unit (PEMU) and positron emission tomography (PET) may be required. Single photon emission computed tomography (SPECT) is a type of nuclear imaging that shows blood flow changes within the brain during a seizure. This helps localize the epileptogenic zone. Children’s Hospital, London Health Sciences Centre is designated as one of two pediatric regional epilepsy surgical centers in Ontario. However, diagnostic testing for surgical candidacy was limited to MRI, PEMU and PET. Prior to this project, collaboration with the adult epilepsy program allowed teenagers >16 to be admitted for SPECT in the adult EMU, which limited accessibility. The purpose of this project was to determine if implementing a pediatric SPECT program was feasible and improved accessibility in a resource limited epilepsy surgery centre.

Methods: In 2019, a quality improvement project was initiated to implement a pediatric SPECT program. Stakeholders from nuclear imaging, paediatric epilepsy, and inpatients were identified. Information was gathered from the literature and programs in North America, as in 2019 there were no other pediatric SPECT programs in Canada. Internal guidelines were created with the goal to admit 1 SPECT within the PEMU per month. This would be a 1-week admission with two 4-hour windows to attempt a SPECT. A nurse would be present to inject and one of the epileptologists to monitor the electroencephalography (EEG). Nuclear radiation safety education was built and provided to the epilepsy staff. Online educational materials were created for children and their families and linked to the epilepsy program website. An electronic medical record order with SPECT was created to help facilitate testing. Well selected patients > 5 years of age were chosen for the test and subsequently admitted for SPECT.

Results: From 2008 to 2020, two teenagers were admitted for SPECT in the adult EMU and neither had a successful scan. In December 2020, the first pediatric SPECT patient was admitted. From December 2020 - May 2022, 15 SPECTS were completed, 11 females and 4 males.  Successful injections were 60% (n=9). Out of the successful injections, 5 were localizing, resulting in 2 successful resective epilepsy surgeries. One to one nursing was initiated by the designated epilepsy program nurse and has extended to over 10 inpatient nurses educated and assisting with injections. The program’s two epileptologists initiated 1:1 EEG monitoring and has now extended to 3 epilepsy fellows.

Conclusions: In conclusion, formalizing a SPECT program within a PEMU utilizing 1:1 care with nursing and specialist assists in completing successful injections. With education and training, engagement of nursing and fellows has grown allowing the team to expand and ease access to admitting children for SPECT. Further research is needed to see what other contributing factors are necessary for successful SPECT testing in resource limited settings.

Funding: None