The Calgary Comprehensive Epilepsy Program

Program Lead: Dr. Samuel Wiebe

Through its strong academic and clinical arms, the Calgary Comprehensive 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 administrative staff. 

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. The CEP clinical research team also continues to have strong collaborations with, and support from, the Brain and Mental Health Research Clinics; an initiative partially funded by DCNS. 

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 adult and pediatric cases are discussed weekly in multidisciplinary conferences in conjunction with 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, electrocorticography, 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 localization.
  • 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. 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 electrical stimulation/neuromodulation. 

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 in organizations such 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, and the Task Forces on Big Data, epilepsy in the elderly, and guidelines of the ILAE.

Important initiatives spearheaded this year by Dr. Wiebe as president of the International League Against Epilepsy include: 1) the development and publication of the Competencies-Based Curriculum for Education in Epileptology. 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. 2) Creation of the ILAE Academy, a comprehensive portal for online education in epilepsy; 3) Creation of ILAE Councils on Education, Congresses, Publications and Global Outreach. 4) Producing, in collaboration with the WHO and the International Bureau for Epilepsy, the first Global Report on Epilepsy. 5) Creation of the Next Generation Initiative in Epilepsy to engage young professionals in the field of epilepsy. 

Dr. Federico is the chair of ILAE Neuroimaging Task Force. As chair, he organized a full day Neuroimaging of Epilepsy course at the 2019 International Epilepsy Congress in Bangkok. The course addressed learning objectives of the new ILAE educational curriculum and it was very well-received. 

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. 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 second Banff International Epilepsy Symposium in February 2019 on the topic of “Epilepsy Across the Lifespan.” In addition to our local speakers, the one-day symposium featured four renowned national and international researchers in the field.
  • The 2018 Mary Anne Lee Memorial lecturer in epilepsy was Dr. Brian Litt from University of Pennsylvania, who spoke about “Big Data, Machine Learning and Collaboration in Translational Epilepsy Research.” 
  • The CEP held its annual epilepsy research retreat, in conjunction with the HBI, with presentations by trainees and prizes for best trainee presentations.
  • 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. He is conducting a clinical trial looking for a new indication for ibuprofen and nifedipine to prevent postictal hypoperfusion.
  • 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. He continues to attract international epilepsy surgery fellows. Importantly, Dr. Hader has garnered support for the acquisition and implementation of state of the art Stereotatictic Laser Interstitial Thermal Therapy in epilepsy, later in 2019.
  • Drs. Sophia Macrodimitris and Ruby Sharma run a successful cognitive behavioural therapy program for epilepsy patients with anxiety and depression, and they offer much needed psychological support for epilepsy patients. They train psychology practicum students through the University of Calgary and residents through the Calgary Clinical Psychology Residency Program. They also provide support for patients with functional neurological symptom disorder (Conversion Disorder) presenting as epileptic seizures. Dr. Joanne Stephen provides psychological services for epilepsy patients at the South Health Campus. 
  • Drs. Lisa Partlo and Kim Goddard use standardized procedures for neuropsychological testing in epilepsy patients across hospitals, providing a uniquely strong team for our CEP. Drs. Brienne McLean and Aaron Mackie, neuropsychiatrists affiliated to the CEP, provide invaluable support to our many patients with psychiatric comorbidities.
  • We were fortunate to recruit a new fulltime neurologist clinical epileptologist to the adult CEP. Dr. Andrea Salmon, who trained at Western University, will be participating in the full scope of activities of the CEP. Dr. Julie Krom, a neurologist neurointensivist with full training in EEG, joined our group in continuous video-EEG monitoring of patients in the intensive care unit. 

There are important developments in pediatric epilepsy this year: 

  • Dr. Juan Pablo Appendino was the chair of the Canadian Board of Registered EEG Technologists and held a successful Canadian examination this year again.
  • Dr. Julia Jacobs from Freiburg, Germany has accepted a position as director of the pediatric epilepsy program and will be starting shortly. 

Dr. Pierre Levan, also from Freiburg, has been jointly recruited by Alberta Children’s Hospital Institute and the Hotchkiss Brain Institute to continue his work on advanced imaging in 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 discovered that a severe hypoperfusion/hypoxic event follows a seizure, which has implications for postictal behavioural dysfunction including paralysis, memory disturbances and Sudden Unexpected Death in Epilepsy.
  • Dr. Quentin Pittman’s lab employs multiple approaches to investigate neuronal function from the entire organism to the single cell. 

This year we graduated two neurophysiology fellows who will be certified in EEG by the Canadian Society of Clinical Neurophysiology—
Dr. Joseph Peedicail from India, and Dr. Amal Al-Mohawes from Saudi Arabia. 

Dr. Karl Martin Klein has successfully established his research 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. He coordinates an international consortium (RAISE-GENIC, funded by the ERA PerMed Cofound) which aims to develop tools that help physicians to select the anti-seizure drug with the best chance of success in individual patients.

Dr. Billie Au (Medical Genetics), Dr. JP Appendino (Pediatrics) and Dr. Karl Martin Klein have established the Genetic Epilepsy Clinic for patients with unsolved genetic epilepsies.

Dr. Wiebe continues to lead the overall CEP.

Dr. Paolo Federico is lead 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 chairs the Clinical Research Unit for the Cumming School of Medicine, and is serving his second year as president of the International League Against Epilepsy.

Members

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

Pediatric Epileptology: Dr. Juan Pablo Appendino, Dr. Alice Ho, Dr. Morris Scantlebury, Dr. Julia Jacobs

Neurosurgery: Dr. Walter Hader, Dr. Yves Starreveld

Neuropsychiatry: Dr. Aaron Mackie, Dr. Brienne McLean

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

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

Neuro-Intensive Care: Dr Julie Krom

Pediatric Neuropsychology: 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, Amar Suchak

Pediatric Neuroradiology: Dr. Xing-Chang Wei

Basic Science: Dr Cam Teskey, Dr Quentin Pitmann, Dr Pierre Levan 

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

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

Pediatric Epilepsy Fellows: Dr. Natarie Liu (graduated)

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

(Updated December 2019)