Dr Sanjeev Rajakulendran is a consultant neurologist at the National Hospital for Neurology and Neurosurgery and Honorary Senior Lecturer at the UCL Institute of Neurology in Queen Square. Dr Rajakulendran has recently brought his expertise in general neurology and his special interest in epilepsy, to a private clinic at the Queen Square Private Consulting Rooms.
In this interview, we discuss his specific areas of expertise and the services that are on offer to patients seeking specialist neurological care in Queen Square.
Q: Dr Rajakulendran, thank you for taking the time to speak with us today. Firstly, would you be able to elaborate a little on your particular area of clinical expertise?
I am a general neurologist with an interest in Epilepsy. Within epilepsy, my interests are broad and range from the management of the ‘first seizure’ all the way through to the long term care of patients with chronic epilepsy. The management of status epilepticus is another area that I am interested in. More recently I have set up subspecialty clinics for patients with metabolic causes of epilepsy and those who wish to explore dietary methods of treating epilepsy such as the Ketogenic diet.
Q: What was it about this particular area of neurology which interested you the most?
Several years ago, I was involved in research into neurological ion channel disorders. These are rare genetic diseases characterised by sudden attacks of unsteadiness, migraines and seizures. Through this period of research I gained insights into aspects of how seizures occurred at a cellular level and this sparked my interest in epilepsy. From a clinical point of view, epilepsy is one of the most common neurological disorders worldwide and affects people of all ages. It is a major cause of neurological disability and can have a significant impact on the patient’s life from a physical, psychological and socioeconomic perspective. There is a vital need to manage all these aspects.
Q: You are involved in the provision of specialist epilepsy clinics at the National Hospital for Neurology and Neurosurgery. Can you tell us more about this?
I run various epilepsy clinics at NHNN. Firstly, I am involved in the ‘First Seizure’ clinic along with my colleague Dr Dominic Heaney. This provides a means through which individuals who have suffered a suspected first seizure can be assessed quickly, typically within two weeks of presentation. If following the consultation, a seizure is considered likely, then appropriate investigations are requested with a view to establishing the diagnosis and preventing further seizures. I also see patients with established epilepsy in my ‘general’ epilepsy’ clinic. Finally I have recently set up two specialist epilepsy clinics; the first is specifically for patients whose epilepsy is part of a syndrome arising from an inborn error of metabolism and the second is to assess dietary methods of treating epilepsy such as the ketogenic diet or its variants. We know that for instance the ketogenic diet is effective in treating certain types of epilepsy in infancy and childhood but very little is known about its efficacy in the adult epilepsy population. This is something I am assessing in collaboration with the metabolic department here at Queen Square.
Q: What advice would you have for referrers when it comes to referring patients whom they suspect may have had a seizure?
If the assessing physician who may be a GP, or an A&E doctor is concerned about a seizure, then that patient should be referred immediately and ideally seen within two weeks of the seizure. They need to consider carrying out some screening investigations such as an ECG, blood tests and if in the emergency department then possibly brain imaging. The patients should be advised about driving and safety and what to do in the event of a further seizure. It is also helpful for us in the First Seizure and Epilepsy clinics if the patient brings along an eye witness.
Q: Where do you think work can be done to improve clinical outcome of those affected by epilepsy? In your opinion, what is on the horizon?
There are many challenges facing clinicians specialising in epilepsy, from diagnosis through to the treatment and management of individuals with chronic epilepsy. From the point of view of diagnosis for example, advances in medical imaging have certainly helped in identifying the cause in more individuals than was possible previously. Similarly, variations of the routine EEG including prolonged recordings, video telemetry and intracranial recordings all have important roles to play. At Queen Square we are fortunate to have access to all these resources. It is important for those individuals with chronic epilepsy to be reviewed in specialist Epilepsy clinics which are well resourced and where future management can be guided by expert hands. In terms of the future, while the vast majority of individuals with epilepsy will be treated with anti-epileptic medications to control or suppress seizures, there is now research being carried out at an experimental level using powerful gene-based techniques to ‘cure’ epilepsy and part of this work has been carried out at Queen Square.
Q: How does holding your clinics in a setting such as Queen Square help you and the patients you see?
There are several advantages to holding clinics at Queen Square. The facilities and resources available are second to none as is the level of expertise. There exists a close relationship between the departments of clinical epilepsy, neurophysiology and radiology such that the relevant tests are easily coordinated, convenient for the patients and undertaken in a timely manner.
Q: You are presenting at our next GP Seminar on July 5th. Would you be able to give an insight into what you will be speaking about?
I will be talking about the management of long term or chronic epilepsy. Approximately a third of individuals with epilepsy will continue to experience seizures despite appropriate pharmacological treatment, so called ‘drug-resistant epilepsy’. Managing these patients is a challenge but it is important to remember that a lot can be done, not only in terms of potentially improving their epilepsy but also other aspects of their care. I hope to provide a practical overview of how these patients can be helped.
Dr Rajakulendran holds regular clinics for private patients at the Queen Square Private Consulting Rooms, 23 Queen Square. If you would like to discuss a referral, please contact his secretary Jennifer Martinez at firstname.lastname@example.org, or by telephone at 020 344 88948.