Primer simposio de epilepsia pediátrica y epilepsia refractaria -El Salvador 2019

The meeting was divided in 3 sections:

Symposium and medical mission in San Miguel, El Salvador:

Part A. Mini epilepsy symposium for pediatricians on 2/24/19. The symposium focused on recognition of common epilepsy syndromes and paroxysmal non epileptic events.

Audience: Around 70 participants, mainly Pediatricians. Supported by the local pediatric society of San Miguel (one of the most important and populated cities in El Salvador)

Part B. Evaluation of clinical cases with local team on 2/25/19. Patients selected by Dr. Rene Silva as chief Pediatric Neurologist. Cases were selected due to refractoriness and potential for epilepsy surgery. Candidates for surgery were identified.

Symposium and medical mission in San Salvador (capital of the country), El Salvador:

Part A. Symposium in pediatric epilepsy and refractory epilepsy on 2/26-28/19.

Audience: About 120

The symposium started with recognition of pediatric epilepsy syndromes, and other topics. The second day focused on drug refractory epilepsy and alternatives to therapy including, ketogenic diet, surgical options/ VNS. Conferences included data about role of CBD in epilepsy. Clinical cases presented by local neurologists or pediatric neurologists were discussed

Part B. Evaluation of pediatric epilepsy cases of difficult control were evaluated by the team at the main hospital (Hospital Benjamin Bloom, the main pediatric hospital in the nation). Many of the cases were candidates for surgical intervention.

One surgical intervention was performed on 2/28 with advise from team members. Most of the surgical candidates were selected for future dates. More cases evaluated on 2/28/19

 Special symposium for patients and families (Jornada especial para familiares y pacientes con epilepsia).

Audience: About 65

The symposium was directed to families and patients, in order to understand new evolving concepts in diagnosis and treatment. Panel of speakers discussed different therapeutic options. Questions from family members were answered. Families spent 8 hours with panel of speakers.

Goal of symposium was to support creation of Salvadorean Epilepsy Foundation. Parents decided to go ahead and take first steps to create the foundation.

Total participants:

Total: 255 participants

Type of audience:

Pediatric neurologists

Pediatricians

Speech therapist

Physical therapists

Family members of children with epilepsy 

Panel of speakers and speaker affiliations:

Manuel Vides MD. MS

Neurodevelopment. Pediatrics.

International fellow AAP

Hospital Centro Pediátrico, Centro Ginecológico, Hospital Diagnóstico y de la Mujer

San Salvador, El Salvador

Claudia Valencia MD

Pediatric Neurology.

Pediatric Neurology in charge of neurology ward. Hospital Benjamin Bloom

San Salvador, El Salvador

Rene Silva MD

Pediatric Neurology

Pediatric neurology in charge

Hospital. Clínica de Especialidades. Nuestra Señora de La paz

San Miguel, El Salvador

Hector Castaneda MD

Neurologist

Ex president Salvadorean Neurology Society

Chief, Neurosience institute, San Salvador, El Salvador

Mauricio Palacios Marchesini MD

Neurology – Epilepsy

Epilepsy surgery program

Neuroscience Institute, San Salvador El Salvador

Angel Hernadez-Mulero MD.

Chief, Pediatric Neurology - Epilepsy

Helen DeVos Children’s Hospital

Grand Rapids, Michigan, USA

Roberto Caraballo M.D.

President, Latin America Affairs, International League against Epilepsy (ILAE).

Chief, Pediatric Neurology, Hospital JP Garrahan.

Buenos Aires, Argentina.

Jorge Vidaurre M.D.

Chair International Affairs Committee, Child Neurology Society

Director Pediatric Clinical Neurophysiology Program

Nationwide Children’s Hospital – The Ohio State University, USA.

Topics covered:

San Miguel:

Case presentation. Pediatric Epilepsy Syndromes (Jorge Vidaurre MD.)

Paroxysmal non epileptic events (Angel Hernadez MD.)

San Salvador.

Medical symposium

New concepts and classification of epilepsies (Roberto Caraballo MD)

Evaluation of first afebrile seizure (Angel Hernadez MD)

Epilepsy syndromes (Jorge Vidaurre MD)

Febrile Seizures (Claudia Valencia MD)

Status epilepticus. An update (Jorge Vidaurre)

Comorbidities in epilepsy (Manuel Vides MD)

Paroxysmal Non epileptic events (Jorge Vidaurre MD)

Use of CBD in epilepsy (Angel Hernandez MD)

Clinical cases (Ricardo Lungo MD)

Lafora disease in El Salvador (Rene Silva MD)

Advances in epilepsy management in Salvador (Mauricio Palacios MD)

When medications do not work (Roberto Caraballo MD)

Clinical cases (Ricardo Lungo MD)

Drug refractory epilepsy (Angel Hernadez MD)

Epilepsy surgery (Angel Hernandez MD)

How to initiate an epilepsy surgery program in El Salvador (Ricardo Lungo MD/Angel Hernadez MD)

Alternative options when surgery is not an option (Angel Hernandez MD)

Ketogenic diet (Roberto Caraballo MD)

Clinical cases (Mauricio Palacios Marchesini MD)

Symposium for families and patients

What is epilepsy (Roberto Caraballo MD)

Why is my son having seizures (Angel Hernandez MD)

Classification of epilepsies. Accurate classification – accurate prognosis and treatment (Jorge Vidaurre MD)

New concepts in epilepsy (Roberto Caraballo MD 

When medications are ineffective (Angel Hernandez MD)

How to create an epilepsy foundation (Hector Castaneda MD    

Economic support and resources of Meeting

The meeting consisted mainly of didactic lectures presented in a practical format. Interactions from audience were allowed.

Salvadorian Pediatric Society, Figueroa family and supporting institutions provided:

Excellent accommodation facilities at Hotel Terraza in San Salvador and Tropico Inn in San Miguel.

Appropriate size conference rooms with state of art audio-visual equipment.

Transportation from and to the airport for all speakers was kindly provided by Figueroa Family

Special Notes:

The Figueroa family (Carlos and Roxana) was instrumental for the organization of the event. Rebeca, her 11 year old daughter was diagnosed with temporal lobe epilepsy at age 7 and finally underwent surgery.

Rebeca Figueroa organized a fundraising event and raised awareness about the importance of bringing new therapies for children with drug refractory epilepsy. Her family used the main local TV channels and newspapers to promote event and invite families to join the symposium.

Dr. Manuel Vides was also a key player in linking the Pediatric and Neurology Societies and working with the Figueroa family for the successful outcome of the event

The participation of Dr. Roberto Caraballo as chair of ILAE Latin America was important to engage and stimulate local programs by representatives of ILAE in El Salvador

Collaborations of Pediatric Neurology and Neurosurgery from the 2 main hospitals in El Salvador was necessary to take the first steps in creation of epilepsy surgery and dietary programs.

Dr. Mauricio Palacios Marchesini worked very hard to classify surgical cases and coordinate collaborative efforts in order to initiate a surgical program in the country

Hospital Diagnostico, one of the main private hospitals supported the team with MRIs, personnel and OR at no cost. Dr. Hector Castaneda coordinated these efforts

Outcomes

The objectives of the symposium were met. Audience was extremely engaging and knowledgeable and provided very positive feedback.

Official certificates of attendance provided to participants of the course

Local team selected potential surgical candidates appropriately. Children with severe, drug refractory epilepsy were evaluated by entire team. One surgery was performed by local team (lesional).

First steps were taken to create a local epilepsy foundation leaded by the Figueroa family

Pediatric neurologists agreed on importance of creating a local Child Neurology Society and they will start meetings to evaluate feasibility.

Future Plans

Pediatric Neurologists requested the continuous support of ICNA, CNS and ILAE to create surgical and dietary programs. Main private hospital ( Diagnostico) agreed to cooperate with public hospitals and share technology required for special surgeries

Local society requested support with travel expenses for neurosurgical personnel for selected cases, so they can be intervened in the near future.