Neurology, Developmental Paediatrics & Rehabilitation
The neurology subspecialty support all the in-patient neurology consultation in Prince of Wales Hospital, including patients in neonatal intensive care unit and special care baby units (SCBU), paediatric and adult intensive care units (for those £18 years old), general paediatric wards (both medical and surgical), the Children Cancer Centre (CCC) and neurosurgical unit. Common conditions that we encounter include acute encephalopathy, central nervous system infections, seizures, acute movement disorders, etc.
We encounter patients with different neurological problems, both developmental and acquired, e.g., global developmental delay, cerebral palsy, neurometabolic conditions, post-encephalitis, traumatic brain injury, etc. With the input and advice from various medical specialties and allied medical professionals, we provide multidisciplinary rehabilitation programme for these patients, helping them tooptimize their potentials and maximally recover their lost functions that has caused functional limitations, such that they could adapt to their living environment at their best potential.
General and special neurology clinics:
There are regular neurology clinics for general neurology patients. Common referrals are developmental problems, epilepsy, headache and tics, etc. We have also special clinics for complicated neurological conditions that require specific attention. These include refractory epilepsy clinics, Headache clinics, Downs Syndrome specialty clinic and botulinum toxin clinic. For the Downs syndrome specialty clinic, we follow the recommended medical surveillance scheme as suggested by the American Academy of Paediatrics. Social worker from the Down Syndrome Association also joins the clinic to support the needs of the patients and their families. We have been having regular sessions for botulinum toxin injection for nearly a decade. Suitable candidates will be assessed by designated senior physiotherapist before injection. Regular follow up after injections are also arranged to assess the efficacy and progress. Standardized assessment protocol and information sheet for injection are also available.
We also have other 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.
Service in our electrophysiology unit includes electroenecephalogram (EEG) monitoring (both standard recording and prolonged in-patient recording), nerve conduction studies, electromyography (EMG) and visual & auditory evoked potentials. We support both in- and outpatient service.
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 physicians, neuropsychologists, and radiologists, etc. 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, usual maximum duration is 5 days per session), special radiology investigations like ictal SPECT, inter-ictal PET, functional MRI, neuropsychology assessments, and WADA tests, etc.
We have regular epilepsy surgery meetings to discuss and formulate the management plan of individual patients. Operations include standard hippocampectomy/ temporal lobectomy, staged operations (intracranial monitoring followed by resective surgery) or palliative procedures (e.g., corpus callosotomy, vagus nerve stimulator implantation, etc).
For selected cases with refractory epilepsy and not suitable for surgical options, we would also provide alternative treatment like ketogenic diet.
We have strong collaboration with orthopaedic surgeons, neurosurgeons, neuroradiologist, neuropsychologists, nurse specialist, occupational therapists, physiotherapists and orthotists, etc. There are regular neuroscience meetings, involving neurosurgeons, adult neurologists, radiologists and pathologists, for various education and case management discussion.
We also have collaboration with our neurosurgeons in managing children with special needs, including those who suffer from traumatic brain injury, brain tumors and dystonia, etc. Our neurosurgeons also support special surgery like deep brain stimulation and intrathecal baclofen pump for refractory dystonia.
Our orthopaedic surgeons are one of the strongest paediatric orthopaedic teams in the territory. They perform various orthopaedic operations on children with special needs, including single event multi-level surgery, dorsal rhizotomy, hip reduction surgery, and scoliosis surgery, etc. We are actively involved in the diagnosis, pre-operative assessment and post-operative rehabilitation and care.
As an academic unit, our team is also actively involved in various researches with close collaboration with adult neurology, neurosurgeon, radiologists and also basic scientists. Selected research areas included:
Association between HLA–B*1502 allele and antiepileptic drugs-induced severe cutaneous reactions in Han Chinese: a Hong Kong-wide population based study
Population genetic study of epilepsy on disease susceptibility and drug resistance
Research in epilepsy surgery
Our teaching covered both undergraduate and postgraduate students. Undergraduate teaching includes didactic lectures, bedside and outpatient teaching.
We also support postgraduate education, which includes paediatric specialty training, teaching for Master course in Neuroscience and Certificate Course in Critical Nursing.