A survey of epilepsy surgery in India

Menon, Ramshekhar; Radhakrishnan, Kurupath

doi:10.1016/j.seizure.2015.01.005

Cited by 25 publications

(10 citation statements)

References 15 publications

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“…Only two surveys reported on the frequency of use of different diagnostic modalities and surgical procedures . Jayakar et al addressed the utility of different presurgical diagnostics in an attempt to reach consensus among epilepsy surgery specialists, nicely illustrating the large variation in the experts' opinions on whether certain tests should be recommended in certain etiologies.…”

Section: Discussionmentioning

confidence: 99%

Current use of imaging and electromagnetic source localization procedures in epilepsy surgery centers across Europe

et al. 2016

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SUMMARYObjective: In 2014 the European Union-funded E-PILEPSY project was launched to improve awareness of, and accessibility to, epilepsy surgery across Europe. We aimed to investigate the current use of neuroimaging, electromagnetic source localization, and imaging postprocessing procedures in participating centers. Methods: A survey on the clinical use of imaging, electromagnetic source localization, and postprocessing methods in epilepsy surgery candidates was distributed among the 25 centers of the consortium. A descriptive analysis was performed, and results were compared to existing guidelines and recommendations. Results: Response rate was 96%. Standard epilepsy magnetic resonance imaging (MRI) protocols are acquired at 3 Tesla by 15 centers and at 1.5 Tesla by 9 centers. Three centers perform 3T MRI only if indicated. Twenty-six different MRI sequences were reported. Six centers follow all guideline-recommended MRI sequences with the proposed slice orientation and slice thickness or voxel size. Additional sequences are used by 22 centers. MRI postprocessing methods are used in 16 centers. Interictal positron emission tomography (PET) is available in 22 centers; all using 18F-fluorodeoxyglucose (FDG). Seventeen centers perform PET postprocessing. Single-photon emission computed tomography (SPECT) is used by 19 centers, of which 15 perform postprocessing. Four centers perform neither PET nor SPECT in children. Seven centers apply magnetoencephalography (MEG) source localization, and nine apply electroencephalography (EEG) source localization. Fourteen combinations of inverse methods and volume conduction models are used. Significance: We report a large variation in the presurgical diagnostic workup among epilepsy surgery centers across Europe. This diversity underscores the need for highquality systematic reviews, evidence-based recommendations, and harmonization of available diagnostic presurgical methods.

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Section: Discussionmentioning

confidence: 99%

Current use of imaging and electromagnetic source localization procedures in epilepsy surgery centers across Europe

et al. 2016

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“…This geographical disparity has been observed in a previous review [21]. A review of epilepsy surgery in India showed that geographical disparity is a common problem, and only 2 centers in big cities contributed to more than 50% of 420 surgeries performed annually, which is far from adequate [183].…”

Section: Discussionmentioning

confidence: 61%

Epilepsy surgery in low- and middle-income countries: A scoping review

Watila

Xiao

Keezer

et al. 2019

Epilepsy & Behavior

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Background: Epilepsy surgery is an important treatment option for people with drug resistant epilepsy. Although surgical procedures are under-utilized worldwide, it is far worse in Low-and Middle-Income Countries (LMIC) and it is less clear to what extent people with drug resistant epilepsy receive such treatment at all. Here we review the existing evidence for the availability and outcome of epilepsy surgery in LMIC, and discuss some challenges and priority. Methods: We used the six stage methodological framework developed by Arskey and O'Malley as a guide. We searched PubMed, Embase, Global Health Archives, Index Medicus for South East Asia Region (IMSEAR), Index Medicus for Eastern Mediterranean Region (IMEMR), Latin American & Caribbean Health Sciences Literature (LILACS), African Journal Online (AJOL), and African Index Medicus (AIM) to identify the relevant literature. Results: We retrieved 148 articles on epilepsy surgery from 31 countries representing 22% of the 143 LMIC. Epilepsy surgery appears established in some of these centers in Asia and Latin America, while some are in their embryonic stage reporting procedures in a small cohort performed mostly by motivated neurosurgeons. The commonest surgical procedure reported was temporal lobectomies. The post-operative seizure-free rates and quality of life are comparable to those in the high-income countries (HIC). Some models have shown that epilepsy surgery can be performed within a resourcelimited setting through collaboration with international partners and through the use of information and communication technology. The cost of surgery is a fraction of what is available in HIC. Conclusion: This review has demonstrated the availability of epilepsy surgery in few LMIC. The information available is inadequate to make any reasonable conclusion of its existence as routine practice. Collaborations with international partners can provide an opportunity to bring high-quality academic training and technological transfer directly to surgeons working in these regions and should be encouraged.

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“…62,139 Beyond our systematic review, there are very sparse LMIC studies on the frequency of STE, including a neurosurgeon survey by Menon and Radhakrishnan in India. 114 Small case series have shown the feasibility of neurosurgical evaluation and treatment for epilepsy in LMICs such as Uganda and Tunisia. 20,92 We elected to use a global survey of neurosurgical volume as our basis for global STE estimates, which yields a more accurate representation of the disproportionate disease burden found in LMICs.…”

Section: Discussionmentioning

confidence: 99%

An estimation of global volume of surgically treatable epilepsy based on a systematic review and meta-analysis of epilepsy

Vaughan

Ramos

Buch

et al. 2019

Journal of Neurosurgery

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OBJECTIVE Epilepsy is one of the most common neurological disorders, yet its global surgical burden has yet to be characterized. The authors sought to compile the most current epidemiological data to quantify global prevalence and incidence, and estimate global surgically treatable epilepsy. Understanding regional and global epilepsy trends and potential surgical volume is crucial for future policy efforts and resource allocation. METHODS The authors performed a systematic literature review and meta-analysis to determine the global incidence, lifetime prevalence, and active prevalence of epilepsy; to estimate surgically treatable epilepsy volume; and to evaluate regional trends by WHO regions and World Bank income levels. Data were extracted from all population-based studies with prespecified methodological quality across all countries and demographics, performed between 1990 and 2016 and indexed on PubMed, EMBASE, and Cochrane. The current and annual new case volumes for surgically treatable epilepsy were derived from global epilepsy prevalence and incidence. RESULTS This systematic review yielded 167 articles, across all WHO regions and income levels. Meta-analysis showed a raw global prevalence of lifetime epilepsy of 1099 per 100,000 people, whereas active epilepsy prevalence is slightly lower at 690 per 100,000 people. Global incidence was found to be 62 cases per 100,000 person-years. The meta-analysis predicted 4.6 million new cases of epilepsy annually worldwide, a prevalence of 51.7 million active epilepsy cases, and 82.3 million people with any lifetime epilepsy diagnosis. Differences across WHO regions and country incomes were significant. The authors estimate that currently 10.1 million patients with epilepsy may be surgical treatment candidates, and 1.4 million new surgically treatable epilepsy cases arise annually. The highest prevalences are found in Africa and Latin America, although the highest incidences are reported in the Middle East and Latin America. These regions are primarily low- and middle-income countries; as expected, the highest disease burden falls disproportionately on regions with the fewest healthcare resources. CONCLUSIONS Understanding of the global epilepsy burden has evolved as more regions have been studied. This up-to-date worldwide analysis provides the first estimate of surgical epilepsy volume and an updated comprehensive overview of current epidemiological trends. The disproportionate burden of epilepsy on low- and middle-income countries will require targeted diagnostic and treatment efforts to reduce the global disparities in care and cost. Quantifying global epilepsy provides the first step toward restructuring the allocation of healthcare resources as part of global healthcare system strengthening.

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A survey of epilepsy surgery in India

Abstract: A steadily increasing number of eligible patients with drug-resistant epilepsy in India are undergoing ES in recent years. This temporal trend of ES in India is in contrast to the recent experience of high-income countries.

Cited by 25 publications

References 15 publications

Current use of imaging and electromagnetic source localization procedures in epilepsy surgery centers across Europe

Current use of imaging and electromagnetic source localization procedures in epilepsy surgery centers across Europe

Epilepsy surgery in low- and middle-income countries: A scoping review

An estimation of global volume of surgically treatable epilepsy based on a systematic review and meta-analysis of epilepsy

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