The neurology subspecialty supports all in-patient neurology consultation in Prince of Wales Hospital, including patients in neonatal intensive care unit and special care baby units (SCBU), paediatric intensive care unit, general paediatric wards, neurosurgical units and orthopaedic unit. Common conditions that we encounter include acute encephalopathy, central nervous system infections, seizures, neuromuscular or movement disorders.
We encounter patients with different neurological problems, both developmental and acquired, including global developmental delay, cerebral palsy, neurometabolic conditions, post-encephalitis and traumatic brain injury. With the collaboration with neurosurgeons, orthopaedics surgeon and allied medical professionals, we provide multidisciplinary rehabilitation programme to help to optimize their potentials, maximally recover their lost functions and minimize their functional limitations in daily lives.
General and special neurology clinics
There are regular neurology clinics for assessing and reviewing patients with developmental concerns, epilepsy, headache and tics. Besides, there are special clinics for complicated neurological conditions include intractable epilepsy clinics, vagus nerve stimulator clinics, neurodevelopmental clinics and botulinum toxin clinics.
We also have multidisciplinary clinics for children with special needs, including Combined Cerebral Palsy Clinics, Combined Neuromuscular Clinics, Movement Disorder Clinics and Epilepsy Surgery Clinics.
To improve the access of clinic service for patients with motor disabilities, we have regular visits to Hong Chi Pinehill Special School for neurology consultations.
We also have regular consultation sessions/ health education sessions to various early training centres and special childcare centres to educate parents of children with special needs/developmental delay and learning difficulties.
We offer services in our electrophysiology unit with electroencephalogram (EEG) monitoring (both standard recording and prolonged in-patient recording), nerve conduction studies (NCS), electromyography (EMG) and visual & auditory evoked potentials (VEP/BAEP).
Botox injection for spasticity or movement disorder
In conjunction with our radiologist and physiotherapist, we offer ultrasound guided botulinum toxin injections to patients with spasticity or focal dystonia. We have regular botulinum clinic session with physiotherapist to assess suitable candidates for botulinum injection and formulate individualized plans to achieve their functional goals. Standardized assessments will be done before and after the botulinum injection to assess the effect.
Intractable epilepsy management, including epilepsy surgery
Our first epilepsy surgery in paediatric patients started in 1998. Since then we have formed a dedicated team for epilepsy surgery, which involves neurosurgeons, adult and paediatric neurologists, neuropsychologists, and radiologists. We would select appropriate cases to assess for suitability/ feasibility for epilepsy surgery. Diagnostic evaluations include high resolution magnetic resonance imaging (MRI), video EEG recording (either standard or prolonged monitoring to capture events), special radiology investigations like ictal SPECT, inter-ictal PET, functional MRI, neuropsychology assessments and WADA tests, etc.
Regular epilepsy surgery meetings are carried out to discuss and formulate the management plan of individual patients. Operations performed include “lesionectomy”, standard hippocampectomy/ temporal lobectomy, staged operations (intracranial monitoring followed by resective surgery) or palliative procedures including hemisphrectomy, corpus callosotomy, vagus nerve stimulator or deep brain stimulator implantation, etc.
For selected cases with refractory epilepsy which are not suitable for surgical options, we also work with dieticians to provide alternative treatment like ketogenic diet.
We have strong collaboration with orthopaedic surgeons, neurosurgeons, neuroradiologist, neuropsychologists, nurse specialist, occupational therapists, physiotherapists, orthotists and dieticians. There are regular neuroscience meetings, involving neurosurgeons, adult neurologists, radiologists and pathologists, for education sessions and case management discussion.
We collaborate with our neurosurgeons in managing children suffering from traumatic brain injury, brain tumors and dystonia. Our neurosurgeons also support special surgery like deep brain stimulation and intrathecal baclofen pump for refractory dystonia.
Orthopaedic surgeons perform various orthopaedic operations on children with neuromuscular disorders and cerebral palsy, including single event multi-level surgery, dorsal rhizotomy, hip reduction surgery, and scoliosis surgery. We are actively involved in the diagnosis, pre-operative assessment and post-operative rehabilitation and care.
Our teaching covered both undergraduate and postgraduate students. Undergraduate teaching includes didactic lectures, bedside and outpatient clinic teaching.
We also support postgraduate education, which includes paediatric specialty training, teaching for Master course in Neuroscience and various EEG courses.
Our team have participated in various clinical studies, e.g., use of ketogenic diet in refractory epilepsy, ketamine use in status epilepticus in children, and umbilical cord blood mononuclear cells in the treatment of neonatal cerebral ischemia, etc.