Complex Epilepsy Service
Mater Children’s Hospital Complex Epilepsy Service provides for the comprehensive assessment and management of children with epilepsy, including a ketogenic diet service, a vagal nerve stimulator therapy service and pre-surgical assessment. This is usually done on a shared-care basis with local medical professionals.
Mater Children’s Hospital Complex Epilepsy Service draws on a wide variety of expertise. See our staff page for details. The Complex Epilepsy Service is provided at Mater Hospital by Dr Kate Riney and Dr Sophie Calvert.
Complex Epilepsy Clinic
The Complex Epilepsy Clinic is run each month and receives referrals from general paediatricians and consultant paediatric neurologists. Children suitable for review in this clinic are those:
- with epilepsy in whom there is diagnostic uncertainty
- who may require inpatient video EEG with drug reduction
- who require assessment for epilepsy surgery such as those:
- who have epilepsy associated with hemiplegia not responding to second line anticonvulsant medication
- with symptomatic focal epilepsy
- children with stereotyped seizures suggestive of focal origin, with or without a lesion on imaging, who have not responded to first line medication
- under two years of age who present with focal seizures associated with a lesion
- who have focal epilepsy associated with specific syndromes
- who have seizures that fail to respond to four different, appropriate anticonvulsant medications
- who require assessment for alternative therapies (eg. vagal nerve stimulation, ketogenic diet)
- with symptomatic epilepsies with continued developmental problems (epileptic encephalopathy) or psychiatric and behavioural problems related to epilepsy.
Ketogenic Diet Clinic
The ketogenic diet is a medical diet used to treat children with seizures that have failed to be controlled by two or more traditional medications. It is a high fat, minimal protein and very low carbohydrate diet that drives the body to use fat as its primary energy source. Fat metabolism results in the production of ketone bodies which are associated with better seizure control in some children. The exact mechanisms of the neuro-protective effect are not yet fully understood.
Children who have been assessed as suitable candidates for the ketogenic diet in the Complex Epilepsy Clinic undergo further assessment and management in the ketogenic diet clinic. The clinic provides a joint neurology, dietetics and nursing service to confirm the suitability of children for the diet and to provide close support for children and families embarking on the diet.
Children who are referred to the clinic are reviewed by paediatric neurologist Dr Sophie Calvert. A specialist paediatric dietitian performs a detailed assessment of each child’s nutritional status and growth history. Calorie requirements, fluid allowances and the correct ketogenic ratio and diet composition are then tailored to each individual. The dietitian works closely with families and carers as they learn about the diet composition, keto recipe design and the monitoring of ketone levels.
The diet requires a five-day hospital stay and a family commitment to a three-month diet trial. Once a child is established on the diet, the child is closely monitored to ensure that meal plans and diet ratios are adjusted to the ketone readings, growth and nutrition requirements of each child. Close support is available to families during sick days and for troubleshooting the many challenges that the diet may present.
These resources have a wealth of information on the ketogenic diet:
Vagus nerve stimulation (VNS) therapy clinic
The Complex Epilepsy Service currently runs a Vagus nerve stimulation (VNS) therapy clinic, offering children with intractable epilepsy the option of this treatment. VNS Therapy is a treatment where an implanted device generates electrical current that is transmitted to the brain via a nerve in the neck. This treatment has been shown to reduce seizures in approximately two thirds of those who have the device inserted.
A dedicated VNS Therapy clinic now assesses patients for their suitability for this therapy, and coordinates pre- and post-insertion care. Referrals to this clinic, run by Dr Kate Riney, are only accepted from paediatric neurologists.
For more information about VNS therapy, download the Vagus Nerve Stimulation manual.
George Gregan Foundation Epilepsy Fellow
Since the start of 2009 the George Gregan Foundation has kindly sponsored an epilepsy fellow for both Mater and Royal Children's Hospitals. This fellow provides support for children with epilepsy in both the outpatient and inpatient setting and is actively involved in audit, research and service development projects.
The Mater Children's Hospital Complex Epilepsy Service is proudly supported by Mater and Queensland Health.