The Calgary Comprehensive Epilepsy Program

Program Lead: Dr. Samuel Wiebe

Through its strong academic and clinical arms, the Calgary Epilepsy Program (CEP) focuses on achieving the best outcomes for patients suffering from epilepsy. This is accomplished through new developments in clinical research, quality improvement initiatives, and comprehensive, interdisciplinary clinical care. The interdisciplinary team includes a highly skilled group of specialists in epilepsy comprising neurologist epileptologists, epilepsy neurosurgeons, neuropsychiatrists, clinical psychologists, neuropsychologists, neuroradiologists, nuclear medicine specialists, clinical assistant physicians, nurses, EEG technologists, clinical neurophysiologists and an epilepsy program administrator. 

The research team has strong collaborations with the Hotchkiss Brain Institute (HBI), the O’Brien Institute for Public Health, and the Alberta Children’s Hospital Research Institute. The team includes basic scientists (HBI), health outcomes and health services researchers, and advanced imaging researchers. 

As a tertiary care centre, the CEP provides care for a wide breadth of persons with epilepsy, including those with complex epilepsies, and those requiring complex surgical investigations and interventions. Complex and surgical cases are discussed weekly in our multidisciplinary conferences in conjunction with our pediatric epilepsy colleagues. 

Core clinical facilities available at the CEP include: 

  • State-of-the-art neurophysiologic assessment, including long-term video-EEG monitoring, day-time video-EEG monitoring, 24-hour ambulatory EEG monitoring, intracranial EEG using multiple modalities of implantation and electrodes, functional brain mapping, and intraoperative monitoring and evoked potentials. Analysis of high frequency oscillations (HFOs) is available and automated detection of HFOs has been developed to facilitate EEG source localisation.
  • Advanced functional imaging includes PET, SPECT, functional MRI with capacity for mapping of cortical function, voxel-based relaxometry and arterial spin labeling, as well as EEG-fMRI interictal and ictal studies.
  • The EEG laboratory operates at four hospital sites and the Seizure Monitoring Unit (SMU) operates at the Foothills Medical Centre and the South Health Campus simultaneously. Continuous video-EEG monitoring is provided at all hospital sites for diagnostic purposes in hospitalized patients, and for seizure management in critically ill patients at all four adult sites in the Calgary Zone.
  • Neuropsychologists, clinical psychologists and neuropsychiatrists focusing on epilepsy provide care to patients in the CEP. 
  • Epilepsy surgery for drug-resistant epilepsy is guided by scalp and intracranial EEG. Surgical techniques include subdural and depth electrodes, stereo-EEG, cortical mapping, the entire breadth of procedures for cortical resection and disconnection, and vagus nerve stimulation. 

Research and Leadership

The CEP houses world-class research teams in prediction models, health services research and outcomes research (Dr. Samuel Wiebe and Dr. Colin Josephson), genomics (Dr. Karl Martin Klein), and in advanced imaging in epilepsy (Dr. Paolo Federico). Members of the CEP serve in leadership positions of the Canadian League Against Epilepsy, the International League Against Epilepsy (ILAE), the North American Commission of the ILAE, the Latin American Commission of the ILAE, the Commission on Diagnostics of the ILAE, as well as in other international neurological organizations.

Dr. Wiebe led the development of the Competencies-Based Curriculum for Education in Epileptology for the International League Against Epilepsy. This systematically developed curriculum and learning objectives are now being used internationally to develop a large variety of educational tools, including distance learning, that can lead to an Assessment-Based Certificate in Epileptology in countries around the world. 

Quality of Care

The CEP has developed a thriving quality of care program that systematically evaluates clinical care and patient outcomes in the SMU and in the epilepsy clinics. Through collaborations with Alberta Health Services and using the data managing services at the Cumming School of Medicine’s Clinical Research Unit, a linkage with administrative health data allows for broader analyses of health resource use and the impact of health care in epilepsy. This year, the CEP database has expanded significantly in scope and aims to promote patient outcomes through integrating clinical, EEG, MRI, genomic, and electronic health records data. Additionally, funding has been secured to create a multicentre consortium on epilepsy clinical data, led by Drs. Josephson and Wiebe, using the CEP clinical database model and structure.

Highlights 

  • The CEP held a very successful First International Banff Epilepsy Symposium in February 2018, focusing on “New Frontiers in Mapping the Epileptogenic Zone”. In addition to our local speakers, the one-day symposium featured four renowned national and international researchers in the field, including Dr. Jean Gotman (McGill University), Dr. Christoph Helmstaedter (University Clinic Bonn), Dr. William Gaillard (George Washington University) and Dr. Samden Lhatoo (Case Western Reserve University). 
  • The 2017 Mary Anne Lee Memorial lecturer in epilepsy was Dr. Lara Jehi from the Cleveland Clinic, who spoke about “Achieving and maintaining seizure freedom after epilepsy surgery”.
  • The CEP held its annual epilepsy research retreat, in conjunction with the HBI, with presentations by trainees from the various clinical and basic science epilepsy research teams.
  • Dr. Paolo Federico in 2017 co-led the Hotchkiss Brain Institute’s Epilepsy NeuroTeam and leads a world-class team which uses fMRI techniques to solve problems of complex epileptogenesis. His research focuses on intracranial EEG-fMRI recordings, Arterial Spin Labeling MRI, and automated High Frequency Oscillation detection algorithms to identify the seizure focus. 
  • Dr. Walter Hader continues to implement robotic implantation of intracranial EEG electrodes in children and adults using the Rosa System, acquired through a donation from Bob and Brenda McNeil. Dr. Raghunath Avanali is the current epilepsy surgery fellow and has had extensive training in pediatric and adult epilepsy surgeries and invasive monitoring under the guidance of Dr. Hader.
  • Dr. Sophia Macrodimitris and Dr. Ruby Sharma run a successful cognitive behavioural therapy program for epilepsy patients with anxiety and depression, a unique offering of the CEP. 

Dr. Joanne Stephen provides similar services at the South Health Campus. Dr. Lisa Partlo and Dr. Kim Goddard have standardized procedures for neuropsychological testing in epilepsy patients across hospitals, providing a uniquely strong team for our CEP. Dr. Brienne McLean with Dr. Aaron Mackie are neuropsychiatrists affiliated to the CEP and provide invaluable support to our many patients with psychiatric comorbidities.

There are important developments in Pediatric Epilepsy: 

  • Dr. Luis Bello Espinosa is the interim leader of the epilepsy program after the retirement of Dr. Jeff Buchalter. There are vigorous recruitment efforts for a new leader.
  • Dr. Juan Pablo Appendino is the chair of the Canadian Board of Registered EEG Technologists and held a successful Canadian Examination this year again.
  • Dr. Rho’s research focus is on the molecular and cellular mechanisms underlying the clinical anti-seizure and neuroprotective effects of the ketogenic diet (KD), an established non-pharmacological treatment for medically intractable epilepsy. 

In the Basic Sciences, the Hotchkiss Brain Institute continues to be a strong partner in various fronts:

  • Dr. Cam Teskey’s CIHR-funded research program examines how seizures alter brain function. His laboratory has recently discovered that a severe hypoperfusion/hypoxic event follows seizures. 
  • Dr. Quentin Pittman’s lab employs multiple approaches to investigate neuronal function from the entire organism to the single cell. 

The CEP runs a unique transition clinic for pediatric patients who are graduating into adulthood. This ensures continuity of care and provides support for patients and families in this significant transition of care. Dr. Yahya Agha-Khani has been running this clinic for the last several years.

This year we graduated one neurophysiology fellow (Dr. Seraj Makkawi) who also became certified in EEG by the Canadian Society of Clinical Neurophysiology. We currently have two international fellows (Dr. Joseph Peedicail from India, and Dr. Amal Al-Mohawes from Saudi Arabia) who actively contribute to a busy program involving outpatient clinics, routine EEG interpretation, and presurgical evaluations including long-term video-EEG monitoring. 

A highlight this year was the recruitment of Dr. Karl Martin Klein who will establish a program in epilepsy genetics and genomics, as well as precision medicine. He retains a special interest in multiplex families with epilepsy as well as adult and pediatric patients with epileptic encephalopathies and thus will be an immediate asset to the program. 

Dr. Wiebe continues to lead the CEP. With Dr. Agha-Khani’s departure, Dr. Paolo Federico took on the directorship of the EEG laboratories, epilepsy clinics, and the SMU. Drs. Shaily Singh and Colin Josephson are the co-directors of education and fellowships. Dr. William Murphy overviews clinical assistants and clinical trials. 

Dr. Wiebe served his final term as associate dean of Clinical Research. He continues to chair the Clinical Research Unit for the Cumming School of Medicine, and was elected President of the International League Against Epilepsy. Dr. Wiebe continues to focus on outcomes and health services research.

Members

Adult Epileptologists: Dr. Paolo Federico, Dr. Alexandra Hanson, Dr. Colin Josephson, Dr. Brain Klassen, Dr. Karl Martin Klein, Dr. William Murphy, Dr. Shaily Singh, Dr. Samuel Wiebe 

Pediatric Epileptologists: Dr. Jong Rho, Dr. Juan Pablo Appendino, Dr. Alice Ho, Dr. Morris Scantlebury, Dr. Luis Bello-Espinosa

Neurosurgeons: Dr. Walter Hader, Dr. Yves Starreveld

Neuropsychiatrists: Dr. Aaron Mackie, Dr. Brienne McLean

Clinical psychologists: Dr. Sophia Macrodimitris, Dr. Ruby Sharma, Dr. Joanne Stephen

Adult Neuropsychologists: Dr. Lisa Partlo, Dr. Kim Goddard

Pediatric Neuropsychologists: Brian Brooks, Marsha Vasserman, Naddley Desire, Sandra Mish, Taryn Fay-McClymont, William MacAllister

Adult Neuroradiology: Dr. James Scott

Nuclear Medicine: Dr. Christine Molnar, Dr. Leonard Numerow

Pediatric Neuroradiology: Dr. Xing-Chang Wei

Clinical Assistants: Dr. Reynaldo Avendano, Dr. Salma Hanna

Adult Epilepsy Fellows: Dr. Seraj Makkawi (graduated), Dr. Joseph Peedicail, Dr. Amal Al-Mohawes

Pediatric Epilepsy Fellows: Dr. Natarie Liu

Epilepsy Nurses: Meliza Camerino, Amira Jivraj, Jackie Martini, Michele Zulinick, Andrea Palmer, Wendy Chen

(Updated Dec. 2018)