Christine Kilpatrick

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Christine Kilpatrick AO FAHMS is an Australian neurologist and the chief executive of Royal Melbourne Health. She has held this position since 2017. Previously, she was the chief executive of the Royal Children's Hospital from 2008 to 2017 and the executive director of Medical Services, Melbourne Health and executive director of the Royal Melbourne Hospital from 2004 to 2008. Before she held these positions, she worked as a neurologist at Royal Melbourne Health and engaged in extensive neurological research, especially epilepsy.

Contents

Career

After earning an MBBS from the Melbourne Medical School, Kilpatrick began a career in neurology. She specialised in the treatment of epilepsy and was in charge of the Royal Melbourne’s Hospital Epilepsy Program for 11 years. [1] During this time period, she participated in numerous studies, most of them involving epilepsy. In 2004, she was appointed Executive Director of Medical Services at the Royal Melbourne Hospital. [2] She then moved away from directly treating patients to health management. She was appointed as the chief executive of the Royal Children’s Hospital in 2008. [3] She held this position for 9 years before being promoted to Chief Executive of Royal Melbourne Health. [4]

Research

Kilpatrick has researched various neurological conditions, with a heavy focus on epilepsy. Some of her research included the effects on late diagnosis of nonepileptic seizures. She concluded that late diagnosis and insufficient criteria definitions significantly lowered a patient's quality of life, and that medical professionals must seek to combine neurological and psychiatric testing for earlier, more accurate diagnoses. [5]

In addition, Kilpatrick investigated hippocampal sclerosis (HS) to better understand its relation to epilepsy. Her work included observing hippocampal surfaces with patients with and without hippocampal sclerosis and epilepsy of the temporal lobe to look for psychological differences. This study found that hippocampus did have different surface structures between those with and without HS, but the seizures themselves were not enough to describe the differences. [6] A similar study found that patients with epilepsy showed increased neural atrophy and hypometabolism of the hippocampus. [7] and In another important study, she worked with patients who had undergone temporal lobe lobectomy to treat hippocampal sclerosis and found that the surgery dramatically reduced incidents of seizures and improved patient’s lives, showing that this treatment can be helpful for some patients. [8]

Kilpatrick also experimented with different visualizing techniques to better identify and diagnose epilepsy. Her work indicated that contrast-enhanced perfusion imaging and diffusion-weighted imaging could be useful for the lateralization of temporal lobe epilepsy (for non-lesion cases). [9]

Another area of study for Kilpatrick was the examination of the effects of various forms of epilepsy and their treatments had on mental health. One such study sought to see how antiepileptic drugs (AEDs) changed the mental health of a patient. After comparing multiple different mental health assessments and the self-reported experiences of the study’s participants, researchers found that AEDs did increase the prevalence of various mental health conditions. Kilpatrick and her partners recommended that further studies be conducted to better understand the long-term mental health implications of AEDs. [10] In addition, Kilpatrick participated in a more recent study where patients with focal epilepsy were assessed for their mental health over an 11 year period. This study found that there was a significant association between non-lesional epilepsy and symptoms of depression. [11]

Significant works

Honours and awards

Related Research Articles

<span class="mw-page-title-main">Hypergraphia</span> Psychological condition wherein a person is compelled to write or draw

Hypergraphia is a behavioral condition characterized by the intense desire to write or draw. Forms of hypergraphia can vary in writing style and content. It is a symptom associated with temporal lobe changes in epilepsy and in Geschwind syndrome. Structures that may have an effect on hypergraphia when damaged due to temporal lobe epilepsy are the hippocampus and Wernicke's area. Aside from temporal lobe epilepsy, chemical causes may be responsible for inducing hypergraphia.

<span class="mw-page-title-main">Ruben Kuzniecky</span>

Ruben Kuzniecky is a neurologist scientist who is Vice-chair academic affairs and professor of neurology at Northwell Health specializing in the field of epilepsy, epilepsy surgery and neuro-imaging.

<span class="mw-page-title-main">Hippocampal sclerosis</span> Medical condition

Hippocampal sclerosis (HS) or mesial temporal sclerosis (MTS) is a neuropathological condition with severe neuronal cell loss and gliosis in the hippocampus. Neuroimaging tests such as magnetic resonance imaging (MRI) and positron emission tomography (PET) may identify individuals with hippocampal sclerosis. Hippocampal sclerosis occurs in 3 distinct settings: mesial temporal lobe epilepsy, adult neurodegenerative disease and acute brain injury.

Focal seizures are seizures which affect initially only one hemisphere of the brain. The brain is divided into two hemispheres, each consisting of four lobes – the frontal, temporal, parietal and occipital lobes. A focal seizure is generated in and affects just one part of the brain – a whole hemisphere or part of a lobe. Symptoms will vary according to where the seizure occurs. When seizures occur in the frontal lobe the patient may experience a wave-like sensation in the head. When seizures occur in the temporal lobe, a feeling of déjà vu may be experienced. When seizures are localized to the parietal lobe, a numbness or tingling may occur. With seizures occurring in the occipital lobe, visual disturbances or hallucinations have been reported.

<span class="mw-page-title-main">Temporal lobe epilepsy</span> Chronic focal seizure disorder

In the field of neurology, temporal lobe epilepsy is an enduring brain disorder that causes unprovoked seizures from the temporal lobe. Temporal lobe epilepsy is the most common type of focal onset epilepsy among adults. Seizure symptoms and behavior distinguish seizures arising from the medial temporal lobe from seizures arising from the lateral (neocortical) temporal lobe. Memory and psychiatric comorbidities may occur. Diagnosis relies on electroencephalographic (EEG) and neuroimaging studies. Anticonvulsant medications, epilepsy surgery and dietary treatments may improve seizure control.

Frontal lobe epilepsy (FLE) is a neurological disorder that is characterized by brief, recurring seizures arising in the frontal lobes of the brain, that often occur during sleep. It is the second most common type of epilepsy after temporal lobe epilepsy (TLE), and is related to the temporal form in that both forms are characterized by partial (focal) seizures.

Anterior temporal lobectomy is the complete or partial removal of the anterior portion of the temporal lobe of the brain. The exact boundaries for removal can vary slightly in practice and between neurosurgeons. It is a treatment option for temporal lobe epilepsy for those in whom anticonvulsant medications do not control epileptic seizures, and who have frequent seizures, and who additionally qualify based on a WADA test to localize the dominant hemisphere for language module.

In the field of neurology, seizure types are categories of seizures defined by seizure behavior, symptoms, and diagnostic tests. The International League Against Epilepsy (ILAE) 2017 classification of seizures is the internationally recognized standard for identifying seizure types. The ILAE 2017 classification of seizures is a revision of the prior ILAE 1981 classification of seizures. Distinguishing between seizure types is important since different types of seizures may have different causes, outcomes, and treatments.

Epilepsy surgery involves a neurosurgical procedure where an area of the brain involved in seizures is either resected, ablated, disconnected or stimulated. The goal is to eliminate seizures or significantly reduce seizure burden. Approximately 60% of all people with epilepsy have focal epilepsy syndromes. In 15% to 20% of these patients, the condition is not adequately controlled with anticonvulsive drugs. Such patients are potential candidates for surgical epilepsy treatment.

ISAS is an objective tool for analyzing ictal vs. interictal SPECT scans. The goal of ictal SPECT is to localize the region of seizure onset for epilepsy surgery planning. ISAS was introduced and validated in two recent studies. This site is a technical supplement to, which should enable ISAS to be implemented at any center for further study and analysis.

Geschwind syndrome, also known as Gastaut-Geschwind, is a group of behavioral phenomena evident in some people with temporal lobe epilepsy. It is named for one of the first individuals to categorize the symptoms, Norman Geschwind, who published prolifically on the topic from 1973 to 1984. There is controversy surrounding whether it is a true neuropsychiatric disorder. Temporal lobe epilepsy causes chronic, mild, interictal changes in personality, which slowly intensify over time. Geschwind syndrome includes five primary changes; hypergraphia, hyperreligiosity, atypical sexuality, circumstantiality, and intensified mental life. Not all symptoms must be present for a diagnosis. Only some people with epilepsy or temporal lobe epilepsy show features of Geschwind syndrome.

<span class="mw-page-title-main">Amygdalohippocampectomy</span>

Amygdalohippocampectomy is a surgical procedure for the treatment of epilepsy. It consists of the removal of the hippocampus, which has a role in memory, spatial awareness, and navigation, and the amygdalae, which have a role in the processing and memory of emotional reactions, both structures forming part of the limbic system of the brain.

<span class="mw-page-title-main">Epilepsy in children</span>

Epilepsy is a neurological condition of recurrent episodes of unprovoked epileptic seizures. A seizure is an abnormal neuronal brain activity that can cause intellectual, emotional, and social consequences. Epilepsy affects children and adults of all ages and races, it is one of the most common neurological disorders of the nervous system. As well as, this condition is more common among children than adults affecting about 6 out of 1000 US children that are between the age of 0 to 5 years old. The epileptic seizures can be of different types depending on the part of the brain that was affected, seizures are classified in 2 main types partial seizure or genralized seizure.

Granule cell dispersion is one of the abnormal structural changes that has been shown in brains of patients with temporal lobe epilepsy. It has also been shown in different animal models, such as the kainic acid model, pilocarpine model, and kindling model. But granule cell dispersion was not found by using perforant pathway stimulation.

People with epilepsy may be classified into different syndromes based on specific clinical features. These features include the age at which seizures begin, the seizure types, and EEG findings, among others. Identifying an epilepsy syndrome is useful as it helps determine the underlying causes as well as deciding what anti-seizure medication should be tried. Epilepsy syndromes are more commonly diagnosed in infants and children. Some examples of epilepsy syndromes include benign rolandic epilepsy, childhood absence epilepsy and juvenile myoclonic epilepsy. Severe syndromes with diffuse brain dysfunction caused, at least partly, by some aspect of epilepsy, are also referred to as epileptic encephalopathies. These are associated with frequent seizures that are resistant to treatment and severe cognitive dysfunction, for instance Lennox-Gastaut syndrome and West syndrome.

The hippocampus participates in the encoding, consolidation, and retrieval of memories. The hippocampus is located in the medial temporal lobe (subcortical), and is an infolding of the medial temporal cortex. The hippocampus plays an important role in the transfer of information from short-term memory to long-term memory during encoding and retrieval stages. These stages do not need to occur successively, but are, as studies seem to indicate, and they are broadly divided in the neuronal mechanisms that they require or even in the hippocampal areas that they seem to activate. According to Gazzaniga, "encoding is the processing of incoming information that creates memory traces to be stored." There are two steps to the encoding process: "acquisition" and "consolidation". During the acquisition process, stimuli are committed to short term memory. Then, consolidation is where the hippocampus along with other cortical structures stabilize an object within long term memory, which strengthens over time, and is a process for which a number of theories have arisen to explain the underlying mechanism. After encoding, the hippocampus is capable of going through the retrieval process. The retrieval process consists of accessing stored information; this allows learned behaviors to experience conscious depiction and execution. Encoding and retrieval are both affected by neurodegenerative and anxiety disorders and epilepsy.

Drug-resistant epilepsy (DRE), also known as refractory epilepsy, intractable epilepsy, or pharmacoresistant epilepsy, is diagnosed following a failure of adequate trials of two tolerated and appropriately chosen and used antiepileptic drugs (AEDs) to achieve sustained seizure freedom. The probability that the next medication will achieve seizure freedom drops with every failed AED. For example, after two failed AEDs, the probability that the third will achieve seizure freedom is around 4%. Drug-resistant epilepsy is commonly diagnosed after several years of uncontrolled seizures, however, in most cases, it is evident much earlier. Approximately 30% of people with epilepsy have a drug-resistant form.

Musicogenic epilepsy is a form of reflex epilepsy with seizures elicited by special stimuli.

Musicogenic seizure, also known as music-induced seizure, is a rare type of seizure, with an estimated prevalence of 1 in 10,000,000 individuals, that arises from disorganized or abnormal brain electrical activity when a person hears or is exposed to a specific type of sound or musical stimuli. There are challenges when diagnosing a music-induced seizure due to the broad scope of triggers, and time delay between a stimulus and seizure. In addition, the causes of musicogenic seizures are not well-established as solely limited cases and research have been discovered and conducted respectively. Nevertheless, the current understanding of the mechanism behind musicogenic seizure is that music triggers the part of the brain that is responsible for evoking an emotion associated with that music. Dysfunction in this system leads to an abnormal release of dopamine, eventually inducing seizure.

References

  1. ↑ "Professor Christine Kilpatrick - Citation for the Award of Doctor of Medical Science (Honoris Causa)". University of Melbourne. 24 November 2016.
  2. ↑ "Professor Christine Kilpatrick AO". The Florey Institute of Neuroscience and Mental Health.
  3. ↑ "Christine a world health leader thanks to Senior Executive MBA". University of Melbourne - Melbourne Business School.
  4. ↑ "Prof Christine Kilpatrick AO (she/her) Chief Executive". The Royal Melbourne Hospital.
  5. 1 2 Jones, Simon G.; O'Brien, Terence J.; Adams, Sophia J.; Mocellin, Ramon; Kilpatrick, Christine J.; Yerra, Raju; Llyod, John H.; Velakoulis, Dennis (2010). "Clinical Characteristics and Outcome in Patients With Psychogenic Nonepileptic Seizures". Psychosomatic Medicine. 72 (5): 487–497. doi:10.1097/PSY.0b013e3181d96550. PMID   20368472. S2CID   23850565.
  6. 1 2 Hogan, R. E.; Carne, R. P.; Kilpatrick, C. J.; Cook, M. J.; Patel, A.; King, L.; O'Brien, T. J. (2008). "Hippocampal deformation mapping in MRI negative PET positive temporal lobe epilepsy". Journal of Neurology, Neurosurgery, and Psychiatry. 79 (6): 636–640. doi:10.1136/jnnp.2007.123406. PMID   17928326. S2CID   6972037.
  7. 1 2 Carne, Ross P.; O'Brien, Terence J.; Kilpatrick, Christine J.; MacGregor, Lachlan R.; Litewka, Lucas; Hicks, Rodney J; Cook, Mark J (2007). "'MRI-negative PET-positive' temporal lobe epilepsy (TLE) and mesial TLE differ with quantitative MRI and PET: a case control study". BMC Neurology. 7: 16. doi: 10.1186/1471-2377-7-16 . PMC   1929122 . PMID   17588263.
  8. 1 2 Lowe, Adrian J.; David, Efraim; Kilpatrick, Christine J.; Matkovic, Zelko; Cook, Mark J.; Kaye, Andrew; O'Brien, Terence J. (2004). "Epilepsy Surgery for Pathologically Proven Hippocampal Sclerosis Provides Long‐term Seizure Control and Improved Quality of Life". Epilepsia (published 18 February 2004). 45 (3): 237–242. doi: 10.1111/j.0013-9580.2004.35903.x . PMID   15009225. S2CID   11966859.
  9. 1 2 O'Brien, T.J.; David, E. P.; Kilpatrick, C. J.; Desmond, P.; Tress, B. (2007). "Contrast-enhanced perfusion and diffusion MRI accurately lateralize temporal lobe epilepsy: A pilot study". Journal of Clinical Neuroscience (published 1 September 2007). 14 (9): 841–849. doi:10.1016/j.jocn.2006.07.003. PMID   17596947. S2CID   11063095.
  10. 1 2 Panelli, Rosemary June; Kilpatrick, Christine; Moore, Susan M.; Matkovic, Zelko; D'Souza, Wendyl J.; O'Brien, Terence J (2007). "The Liverpool Adverse Events Profile: Relation to AED Use and Mood". Epilepsia (published 5 March 2007). 48 (3): 456–463. doi: 10.1111/j.1528-1167.2006.00956.x . PMID   17284301. S2CID   24655401.
  11. 1 2 Adams, Sophia J.; O'Brien, Terence J.; Lloyd, John; Kilpatrick, Christine J.; Salzberg, Michael R.; Velakoulis, Dennis (2008). "Neuropsychiatric morbidity in focal epilepsy". The British Journal of Psychiatry (published 2 January 2018). 192 (6): 464–469. doi: 10.1192/bjp.bp.107.046664 . PMID   18515901.
  12. ↑ "Close-up: Professor Christine Kilpatrick" (published 20 September 2013). 19 September 2013.
  13. ↑ "2014 Victorian Honour Roll" (PDF).
  14. ↑ "Distinguished Fellow Award".
  15. ↑ "TOP 50 PUBLIC SECTOR WOMEN (VIC) 2018".
  16. ↑ "2019 Queen's Birthday Honours". University of Melbourne (published 12 June 2019). 12 June 2019.
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