Study On The Management And Application Of Multidisciplinary Team Clinic For Children Epilepsy In General Hospital

Objectives: To evaluate the management and application of multidisciplinary team(MDT)clinic for children epilepsy in general hospital.Methods: This prospective study on epileptic children in MDT clinic of epilepsy center of our hospital from January 12,2018 to November 26,2019.The inclusion and exclusion criteria were established definitely.Before applying for the MDT clinic,children should be diagnosis and treatment by pediatric neurologist.The relevant data of children were collected,and the personalized MDT was built(the MDT was mainly composed of pediatric neurologist,neurosurgeons,neuroimaging physicians and electroencephalography practitioner,and adjusted other consultants including nutritionist,clinical pharmacist,geneticist and other professional doctors who were specialists registered in MDT database according to the clinical characteristics and the consultation content of the patient),standardized MDT procedures(including medical record preparation,medical history report,disease evaluation,discussion,diagnosis and treatment suggestions from MDT,and data on file)were established to discuss and make comprehensive recommendations.The clinical characteristics of pediatric epilepsy in MDT clinic were analyzed,the implementation of the diagnosis and treatment recommendations from MDT were collected,and the therapeutic effect and medication compliance were followed up after 3 months.The management and application of MDT clinic for children epilepsy in general hospital were further evaluated.Results:(1)A total of 121 children(89 male,32 female)were enrolled in this study.The age ranged from 4 months to 20,mainly school age.In the past of history,most of them had abnormal perinatal history.99 cases(81.8%)for drug-resistant epilepsy,12 cases(9.9%)for poor curative effect with single drug therapy and 1 case(0.8%)for assessing the time of drug withdrawal.(2)Diagnosis and classification of epilepsy: The main types of epileptic seizures were focal origined motor seizures with perceptual impaired.In these cases,2 cases(1.7%)with Dravet syndrome,1 case(0.8%)with Lennox-Gastaut syndrome,23 cases(19.0%)with West syndrome,11 cases(9.1%)with epilepsy with continuous spike-waves during slow sleep,8 cases(6.6%)with absence epilepsy.The etiology of epilepsy accounted for immunized(0 case),infectious(1 case),metabolic(2 cases),hereditary(8 cases),structural(53 cases),unknown(57 cases).35 cases comorbid with intellectual developmental disorder,1 case with attention deficit hyperactivity disorder and specific learning disorder,1 case with autistic spectrum disorder.(3)Treatment recommendations: Behavior therapy after drug withdrawal was recommended to 1 patient(0.8%).5 cases(4.1%)were advised to do preoperative evaluation,surgical intervention were advised to 7 cases(5.8%).Vagus nerve stimulation were recommended to 13 cases(10.7%),and ketogenic diet therapy were advised to 37 cases(30.6%),antiepileptic drug adjustment were recommended to 58 cases(47.9%),and those who comorbid with neuropsychiatric disorders were advised to do rehabilitation training in 37 cases(30.6%).(4)Implementation and follow-up of MDT recommendations: A total of 97 patients were followed up.91 cases(91/97,93.8%)had implemented the recommendations and those recommendations were effective in 78 cases(78/91,85.7%.).Including 2cases(2/91,2.1%)underwent radiofrequency thermocoagulation,11 cases(11/91,12.1%)were performed focal resection,24 cases(24/91,26.4%)received ketogenic diet therapy,41 cases(41/91,45.1%)were adjusted antiepileptic drug therapy.Among the children with comorbid intellectual developmental disorder,10cases(28.6%)showed intellectual developmental improvement.Conclusion: The pathogenesis of children with epilepsy is complicated.They often suffer from intellectual developmental disorder,attention deficit hyperactivity disorder,autistic spectrum disorder,specific learning disorder,etc.Besides,it is faced with the problems of poor treatment compliance and cross-specialty continuous treatment.To treat the children with epilepsy needs cooperation from pediatric neurologist,neurosurgeons,neuroimaging physicians,electroencephalography practitioner,clinical pharmacist,nutritionist,neurologist,neurorehabilitation physicians,psychologist,geneticist and other specialists.According to the clinical characteristics of patients,personalized MDT was built and the standard procedure and management was established in this study,which can not only improve the treatment efficiency of refractory epilepsy,the compliance of patients,and the stability of treatment,but also promote the comprehensive understanding of epilepsy among various specialists,which was successful,and provides reference for other complicated diseases with difficulty in diagnosis and treatment so that children can get more more professional diagnosis and treatment from MDT clinic.