Epilepsy surgery in China: past, present, and future

Abstract

Since the 1990s, China has experienced a boom in epilepsy surgery. Five cities have established epilepsy centers, and at least one hospital in each of the 32 provinces provides epilepsy surgical services. Epilepsy surgery in China has benefited from the availability of advanced non‐invasive diagnostic tools to delineate epileptogenic lesions and epilepsy functional deficits, increased medical and social acceptance of epilepsy surgery, and collaborations with the International League Against Epilepsy, the International Bureau for Epilepsy, and international epilepsy centers. However, national demand for epilepsy surgery still far exceeds supply, and epilepsy surgery is underutilized in many economically underdeveloped provinces. This paper analyzes the current progress of epilepsy surgery in China and details necessary steps for future development. Specifically, the growing need for standardized quality control, multidisciplinary research, and continued worldwide collaboration is addressed. Surgical therapy for epilepsy has experienced rapid growth in recent years, but many patients with active epilepsy did not receive appropriate treatment in China. Improved epilepsy education remains an important tool to correct the treatment gap. Epilepsy surgery has rapidly grown in China. The establishment of additional epilepsy centers, enhancement of multidisciplinary cooperation, standardization of surgical indications and techniques, increased public education, and government recognition of epilepsy treatment as a medical priority are interventions that will improve the surgical treatment of people with epilepsy in China.

Epilepsy in Asia: Disease burden, management barriers, and challenges

“…The use of epilepsy surgery varies throughout Asia, being well developed in some countries and less so in others . Higher‐income countries such as Hong Kong, Japan, Korea, and Taiwan each have several active epilepsy surgery centers, with favorable results (Table ) . However, the services are likely to be underutilized given the number of patients who could benefit from epilepsy surgery, and changing trends in epilepsy management and newer therapeutic procedures require ongoing training programs…”

A survey of epilepsy surgery in India

“…Our study revealed that, in between 1995-2000 and 2007-2012 periods, the number of ES carried out together in two leading centers in India has increased by more than 3-fold. In China, the number of ES undertaken in major centers increased from 600 before the year 2000 to 1100 in 2005 [10]. While the centers in China were uniformly distributed across the country with at least one hospital in each of the 32 provinces engaged in ES [10], 9 out of 18 centers in India were located in the southern part of the country.…”

“…In China, the number of ES undertaken in major centers increased from 600 before the year 2000 to 1100 in 2005 [10]. While the centers in China were uniformly distributed across the country with at least one hospital in each of the 32 provinces engaged in ES [10], 9 out of 18 centers in India were located in the southern part of the country. On the negative side, despite the increase in the number of ES, both in India and China, demand for ES still far exceeds supply.…”

“…With less than 500 ES being undertaken annually, currently, only 1 in 1000 eligible patients in India undergoes ES. It has been estimated that in China there are approximately 1.8 million potential surgical candidates, but not more than 2500 ES are currently being undertaken per year in that country [10].…”

Noninvasive investigations are essential tools for epilepsy surgery in developing countries: Extrapolating results from Chinese studies

“…For example, as pointed out by Xu and Xu[2] there is still a wide treatment gap in China as many patients with active epilepsy still do not get epilepsy surgery. So we propose that the results of the studies in our country in context of the surgical treatment of epilepsy can be quite helpful in executing related programs in other developing countries; especially because there is abundant published data of epilepsy surgeries from China, it would be an advantage for us to take a closer look at the results.…”