Welsh Research and Education Network
Hot topics in research and medical education, in Wales and beyond
3rd-5th January 2018,
I had the pleasure of being able to attend the British Paediatric Neurology Association Annual Conference this year held at King’s College London. Despite a horrendous viral illness over the festive season which left me with significant post-viral fatigue, I managed to catch my early train to London on the 3rd of January (and had the pleasure of travelling first class in view of my tardiness in buying the ticket resulting in the first class ticket being cheaper!). Loaded up with free coffee and biscuits from the first class carriage, I arrived in London just in time for the first session. The venue was great, close to Waterloo Bridge, and there were beautiful views of the city to be seen in the evenings when crossing the bridge to attend the social events.
The conference had a packed programme full of interesting talks, clinical practice sessions, e-posters and symposia. One of the highlights included the opening talk by Dr. Charlie Fairhurst who discussed the creation of the NICE guideline for Cerebral Palsy in under 25’s in which he emphasised the importance of treating pain first and foremost because if a child is in pain, there is no point in complex interventions to improve their mobility/social interaction because the pain will hinder the child’s participation. Patients with Cerebral Palsy are particularly at risk of pain from numerous sources (e.g. orthopaedic/muscular problems, GI dysmotility, pressure sores, dystonia etc. in addition to the usual causes of pain that anybody can experience). I felt that the talk also provided a very important reminder of the need for holistic and multi-disciplinary care.
There were multiple presentations throughout the conference on current research ongoing in neurological disorders (including neuro-inflammation in psychiatric disorders, antibodies in neuro-inflammatory and demyelinating disorders, neurogenetics etc.) which really made me appreciate the rate at which our understanding of neurological disorders is advancing. There were also sessions on Neuroimaging including advances in fetal neuro-imaging (talk given by Prof. Mary Rutherford) and advances in PET scanning particularly in guiding epilepsy surgery.
On the first day, I attended a workshop on Childhood Sleep Disorders run by the tertiary sleep service at Evelina Children’s Hospital, which involved learning about methods of sleep assessment (including polysomnography, actigraphy and sleep diaries). Pharmacological therapy including melatonin and clonidine (for fragmented sleep) were discussed. We also discussed potential contributors to sleep fragmentation (e.g. pain, seizures, obstructive sleep apnoea) and also discussed basic sleep hygiene advice and psychological interventions to help with behavioural insomnia.
On day 2, I attended a workshop session on early epileptic encephalopathies and the emergence of underlying diagnoses related to epilepsy gene panels where the indications for genetic testing were discussed. We also discussed when a referral to a clinical genetics service is indicated and the common genetic mutations now being identified on epilepsy panels (SCN1a, SCN8a, SCN2a, KCNQ2, PRRT2 etc).
On the third day, I attended a workshop on movement disorder emergencies including how to manage status dystonicus. This was something I had never come across in clinical practice and therefore was a very useful session highlighting the management including pain relief, dystonia medications, checking CK, strict fluid management. The session also discussed common mutations causing dystonia (including DYT 1, PANK2, RRT1, TOR1A) and also discussed surgical management options including deep brain stimulation and pallidectomy.
This year’s conference used an app instead of the usual printed programme. The app allowed you to formulate your own personal programme and came with alerts to indicate which talks were about to start. During talks, you could also write notes on the app which were then linked to the talk. At the end of the conference you could then download all of your notes. There was also an option to ‘chat’ with other attendees during the talks (though I didn’t use this feature as I felt I didn’t have anything very intelligent to say as many of the topics were completely new to me!).
During the conference, I presented my poster on head injuries sustained following infant falls on the postnatal ward. The poster outlined the findings of a case series of infant falls in UHW between January 2015-September 2017. We found a high incidence of injury on CT imaging in these infants and therefore we propose a lower threshold for CT imaging in this group. We also found significant variation in monitoring, investigation and follow-up of these patients highlights a need for guideline development in this area. I am now planning to expand this project to a multi-centre WREN project collecting data from other units across Wales to gain more insight in to the scale of this problem and how cases are managed elsewhere across Wales.
I was very pleased to see that two other Wales Deanery Trainees also had posters to display at the conference. Anne-Marie Proctor with her poster on Improving EEG investigations: Child’s Play? This poster presented how extension of a child-centred approach to EEG (including play therapy and flexibly timed investigations) to a second site in ABMU improved EEG success rates. Qumrun Nahar also presented her poster on the delivery of Botulinum Toxin Injection for Children with Spasticity: a Service Evaluation Project in Pembrokeshire, West Wales which showcased the service model of Botulinum Injections delivered in a rural DGH.
This year’s conference displayed all of the posters as e-posters which meant that poster presenters were given a 3 minute slot to present their poster as part of a powerpoint presentation in a designated room. All presenters had 2 minutes to present and 1 minute for questions. Numerous poster presentations were running in parallel. The positive side of this was having an allocated time session to present your poster, and then you were free to listen to the other posters being presented with no obligation to stay standing next to your poster. The down-side was that because of the parallel sessions it was easy to miss out on seeing another poster that took your interest. For example, unfortunately I couldn’t attend both Anne-Marie and Qumrun’s poster presentations and was very sad to have to miss out on seeing one completely. There were also some posters which I felt could have generated much more than three minutes’ discussion and it was a shame to be limited to that timescale (some of the presenters struggled to describe their poster in any sort of detail in only 2 minutes!). It was an interesting and innovative way to display posters and it will be interesting to see if the idea is taken up at other conferences.
I was absolutely exhausted at the end of the three days, but know that I have learnt a great deal that will improve my interaction with children with neurological disorders, their families and the wider MDT.
You can download the BPNA app which has further information on upcoming BPNA courses and events. And if you have an interest in Paediatric Neurology I would thoroughly recommend attending the BPNA conference next year.
And if anybody is interested in getting involved in the upcoming WREN project looking at Head Injuries in Neonates on the Postnatal Ward please get in touch at firstname.lastname@example.org!
Dr Annabel Greenwood