Establishment of a Comprehensive Epilepsy Center in Pakistan: Initial Experiences, Results, and Reflections

Abstract

Background. Developing countries, home to 80% of epilepsy patients, do not have comprehensive epilepsy surgery programs. Considering these needs we set up first epilepsy surgery center in Pakistan. Methods. Seventeen teleconferences focused on setting up an epilepsy center at the Aga Khan University (AKU), Karachi, Pakistan were arranged with experts from the University of Alberta Hospital, Alberta, Canada and the University of West Virginia, USA over a two-year period. Subsequently, the experts visited the proposed center to provide hands on training. During this period several interactive teaching sessions, a nationwide workshop, and various public awareness events were organized. Results. Sixteen patients underwent surgery, functional hemispherectomy (HS) was done in six, anterior temporal lobectomy (ATL) in six, and neuronavigation-guided selective amygdalohippocampectomy (SAH) using keyhole technique in four patients. Minimal morbidity was observed in ATL and, SAH groups. All patients in SAH group (100%) had Grade 1 control, while only 5 patients (83%) in ATL group, and 4 patients (66%) in HS group had Grade 1 control according to Engel's classification, in average followups of 12 months, 24 months and 48 months for SAH, ATL, and HS, respectively. Conclusion. As we share our experience we hope to set a practical example for economically constrained countries that successful epilepsy surgery centers can be managed with limited resources.

Systematic review and network meta-analysis of resective surgery for mesial temporal lobe epilepsy

“…There were more studies that were included in our meta-analysis compared with prior meta-analyses by Josephson et al 5 and Hu et al 4. In particular, there were seven studies that were not included in prior meta-analyses—Arruda et al ,39 Renowden et al ,48 Tahir et al ,51 Sagher et al ,49 Bujarski et al ,41 Wendling et al 54 and Nascimento et al 46—which demonstrated no significant difference in seizure-free outcome of ATL versus SAH. The inclusion of new data from these studies may have contributed to differences in this study’s conclusion relative to prior meta-analyses.…”

Comparisons of the seizure-free outcome and visual field deficits between anterior temporal lobectomy and selective amygdalohippocampectomy: A systematic review and meta-analysis

“…1). Six studies were excluded for the following reasons: non-blind randomized trial [18], number of patients less than 20 [19,20], followup for less than 1 year [21,22], and overlapping patient population [23]. Twenty-six articles which included 2930 cases (1390 cases under SAH and 1540 cases under ATL) met the inclusion criteria for metaanalysis.…”

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

“…Information on whether they had sufficient qualified personnel or adequate training was mainly not mentioned or difficult to extract. Some papers reported on collaborative work between HIC and LMIC in Uganda [36][37][38], Tunisia [41], Thailand, India and Argentina [83,105], Pakistan [168], and Iran [171]. The collaborative epilepsy surgery program between North America and the CURE Children's Hospital of Uganda (CCHU) assessed the feasibility of an epilepsy surgery program in a resource-poor setting using just videoelectroencephalography (EEG) and computed tomography (CT) volumetric analysis [38].…”

“…Table 5 showed that the indicators of QOL improved after surgery [37,47,50,59,93,98,101,122,126,134,159,160,165,175,177], except in one study [62]. Table 6 reports on the cost of epilepsy surgery [66,70,71,114,117,144,147,164,168,171,172] and VNS [138], the cost of epilepsy surgery as at 2014 ranges between US$500 in Iran to approximately US$8,000 in China.…”