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Page 4 of 9 Neuroimmunol Neuroinflammation 2018;5:37 I http://dx.doi.org/10.20517/2347-8659.2018.45

Conclusion: Stroke is a major cause of mortality and morbidity in North Central Nigeria. Community
screening for risk factors should be pursued aggressively and identified risk factors managed promptly
in order to reduce the burden of this pandemic. Siriraj stroke sub-typing can be used in resource limited
setting like ours where neuroimaging facilities are either not available or too expensive.

5. How to choose different treatment modalities? A retrospective study of seizure
outcome in resective epilepsy surgery, vagal nerve stimulator and ketogenic diet in
paediatric refractory epilepsy and their underlying etiologies; sharing experience in

Tuen Mun Hospital /a regional referral center in HKSAR

Mario Wai Kwong Chak, Sui-To Wong, Fong Wai Man

Tuen Mun Hospital

Aim: To retrospectively study effectiveness of seizure control by resective epilepsy surgery, vagal nerve
stimulator and ketogenic diet/modified Atkin diet in paediatric refractory epilepsy in Tuen Mun Hospital,
HKSAR and what are the patients’ underlying etiologies.

Methods: Children and adolescences with medical refractory epilepsy underwent resective epilepsy surgery,
vagal nerve stimulator and ketogenic diet/modified Atkin diet in Tuen Mun Hospital were recruited to study
seizure outcome and underlying etiologies. We use Engel Classification to measure seizure outcome after
epilepsy surgery: the seizure outcome of KD/MAD categorized into groups as: (1) seizure free; (2) > 75%
seizure reduction; (3) 50%-75% seizure reduction; and (4) seizure no change. The seizure outcome after vagal
nerve stimulator categorized into groups as: (1) > 50% seizure reduction; and (2) Seizure no change.

Results: Forty-four patients underwent resective epilepsy surgeries from 2001 to July 2018. Age for surgery
ranged from 0.8-19 years (mean 10.4 years). Follow-up duration ranged from 0.1-16 years (mean: 6.2 years)
included 22 patients who underwent temporal lobe surgeries; 14 patients underwent extra-temporal lobe
surgeries; 4 patients underwent hypothalamic hamartoma resection; 3 patients underwent disconnection
or hemisphereotomy. Seizure outcome in respective epilepsy surgery: in temporal lobe surgeries n = 22,
Engel I: 82%; Engel II: 4%; Engel III: 8%; Engel IV: 8%. Etiologies: mesial temporal sclerosis: 41%; focal
cortical dysplasia: 36%; developmental low grade tumor: 18%; gliosis: 5%. In extra-temporal lobe surgeries
n = 15, Engel I: 64%; Engel III 36%. Etiologies: focal cortical dysplasia: 53%; cortical tuber 13%; ulgyria: 7%;
haematoma/cavernous hamangioma: 13%, porencephaly: 7%; glial nodule: 7%. In hypothalamic hamartoma
surgery, Engel I: 50%; Engel II: 25%; Engel IV: 25%. For disconnective surgery included 1 TPO disconnection
& 2 hemispherotomy, Engel I: 33%; Engel II: 33%; Engel IV: 33%. Total 6 patients underwent vagal nerve
stimulator implantation from 2014 to 2018. Three patients underwent re-implantation after VNS out of
battery. Age of first implantation n = 6 ranged from 3-22 years (mean age: 16.5 years). Duration of follow
up: ranged 1-5.5 years (mean 3.7 years).The underlying etiologies inlcuded post-FIRES epilepsy, bilateral
mesial temporal sclerosis, lennox gastaut syndrome, 2 subcortical band heterotropia, symptomatic epilepsy
with history of status epilepticus due to TBC1D24 mutation. Three patients had > 50% seizure reduction
with etiologies included post-FIRES epilepsy, LGS, TBC1D24 mutation. Three patients with no change in
seizure control with etiologies 2 subcortical band heterotropia, bilateral MTS. Twenty-one patients put on
ketogenic diet/ modified Atkin diet from 2001 to July 2018. Age to start KD/MAD ranged from 0.3 year to
11 years (mean age: 5 years). Duration of follow up ranged from 2 months to 232 months (mean 32 months).
Three patients became seizure free with etiologies as congenital CMV infection, Landau Kleffner Syndrome,