Case number 10 : Dandy-Walker syndrome

Ms. SA is an 8-year-old known case of Dandy-Walker syndrome managed through supraventricular and infraventricular peritoneal shunts. Having acquired normal developmental milestones till seven years of age, she currently has cognitive impairment, gait abnormality and speech defects following shunt complications.peer-reviewe

Video-EEG long term monitoring as a new service at Mater Dei Hospital

Introduction: Video-EEG long-term monitoring (LTM) was introduced into Mater Dei Hospital (MDH) in May 2012. The audit aims to evaluate LTM in terms of diagnostic outcomes and impact on patient management. Methods: Analysis was carried out after retrospective review of 30 inpatients who underwent LTM at MDH between May 2012 and May 2014. 31 LTM sessions were performed. Referrals were made by 3 consultant neurologists. LTM and medical records were compared to evaluate whether LTM determined a change in diagnosis and how this affected management outcomes. Results: Patient ages ranged from 3 months to 73 years (35.5% paediatric cases) (16 male , 15 female studies). The most common indication was for uncontrolled seizures (54.8%), followed by suspected non-epileptic seizures (NES) (29%). The average hospital stay was 2 days for paediatric patients and 5 for adult cases. Major monitoring interruptions were recorded in 5 paediatric and 1 adult case. Comparing pre- with post-LTM diagnosis showed that the investigation changed or identified a new diagnosis in 38.7%, confirmed the diagnosis in 29%, and was inconclusive in 32.3% (inconclusive in 45.5% of paediatric cohort and 25% of adult cohort). It led to medication optimisation in 38.7% and neuropsychiatry referrals in 22.6%. The remaining were unchanged, not followed up or referred for other tests. None were referred for surgery. Conclusion: LTM is an important tool which influenced patient management through changes in medication or referrals in 64.5% of cases. Continuous evaluation of the techniques used and resources available is recommended to increase the yield of conclusive LTM studies.peer-reviewe