Establishment of epilepsy surgery in Peru

Steven, David; Vásquez, Carlos M.; Delgado, Jose C.; Zapata-Luyo, Willy; Alonso-Becerra, Alicia; Barreto, Elliot; Arango, Miguel; Burneo, Jorge G.

doi:10.1212/wnl.0000000000006029

Cited by 8 publications

(10 citation statements)

References 3 publications

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“…Notably, the strong partnership overcame diverse challenges such as the lack of personnel and infrastructure to provide continuous functioning of the video electroencephalography unit, and the patient idiosyncrasy about the disease’s nature. [ 36 ] Over the years, this collaboration has resulted in an integrated approach to epilepsy surgery and created opportunities for peruvian physicians to continue their profesional development abroad.…”

Section: Resultsmentioning

confidence: 99%

The humanitarian aid of neurosurgical missions in Peru: A chronicle and future perspectives

Bocanegra-Becerra¹,

Castillo-Huerta²,

Ludeña-Esquivel³

et al. 2022

Surgical Neurology International

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Background: The unmet neurosurgical need has remained patent in developing countries, including Peru. However, continuous efforts to overcome the lack of affordable care have been achieved, being neurosurgical missions one of the main strategies. We chronicle the humanitarian labor of organizations from high-income countries during their visit to Peru, the contributions to local trainees’ education, and the treatment of underserved patients. Furthermore, we discuss the embedded challenges from these missions and the future perspective on long-term partnerships and sustainability. Methods: This is a narrative review. We searched the literature in PubMed and Google Scholar about neurosurgical missions conducted in Peru. Results: Since 1962, twelve organizations from high-income countries have delivered humanitarian help in Peru by training local neurosurgeons, treating low-income patients, and providing surgical instrumentation. Out of the three main regions of Peru, cities on the coast and highlands have hosted most of these missions, with no reported outreach in the amazon area. About 75% of the organizations are headquartered in the United States, followed by Canada, Luxembourg, and Spain. In addition, 50% of the organizations have an active partnership. The predominant focus of these missions has been pediatrics, neuro-oncology, and spine surgery. Conclusion: Neurosurgical missions have represented a strategy to close the disparity in education and treatment in Peru. However, additional efforts must be conducted to improve long-term partnership and sustainability, such as adopting standardized indicators for progress tracking, incorporating remote technologies for continuous training and communication, and expanding partnerships in less attended areas.

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Section: Resultsmentioning

confidence: 99%

The humanitarian aid of neurosurgical missions in Peru: A chronicle and future perspectives

Bocanegra-Becerra¹,

Castillo-Huerta²,

Ludeña-Esquivel³

et al. 2022

Surgical Neurology International

View full text Add to dashboard Cite

show abstract

“…Despite challenges, epilepsy surgery can enhance the quality of life for those with epilepsy, and extending access is imperative for healthcare equity. 8,12 The patients mostly came from Lima, where the only two epilepsy surgery centers in the country are situated. Patients from other regions of the country may have encountered obstacles due to various factors, including sociodemographic, cultural, and economic reasons.…”

Section: Discussionmentioning

confidence: 99%

“…6 However, it remains substantially underutilized globally, particularly in low-and middle-income countries (LMIC) like Peru. 7,8 Identifying factors for long-term seizure freedom is crucial. This study aimed to report, for the first time, the surgical outcomes of MTLE-HS patients in a Peruvian epilepsy surgery center over the last decade.…”

Section: Introductionmentioning

confidence: 99%

Postsurgical outcomes in a cohort of patients with hippocampal sclerosis: Initial experience in a referral epilepsy center in Peru

Ramirez¹,

Zuñiga²,

Boluarte³

et al. 2023

Epilepsia Open

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Mesial temporal lobe epilepsy, one of the most common forms of epilepsy, is often linked with drug resistance. Surgical intervention is a reliable and safe treatment option, though research into postsurgical outcomes in our locality remains limited. We performed a retrospective observational study included 91 patients with mesial temporal lobe epilepsy and hippocampal sclerosis who had undergone anterior temporal lobectomy between 2012 and 2020 at a surgical epilepsy center located in Lima, Peru. Postoperative outcomes were analyzed using bivariate and multivariate analysis based on the Engel classification. We found that after 12 months of follow‐up, 78.65% of the 91 patients achieved an Engel IA classification, while 9.09% attained Engel IB classification and 11.24% were designated as Engel II, with only 1.12% classified as Engel IVA. The median QOLIE31 score was 84 (IQR: 75–90), with 74.16% of the participants successfully reintegrating into academic or employment activities. After 24 months, only 68 patients completed the follow‐up, with 69.12% achieving an Engel IA classification. Individuals with a secondary education or higher were more likely to achieve an Engel IA classification at 12 months (OR: 5.11; P = 0.005; CI: 1.63–16.01), after adjusting for sex and age. We concluded that most patients exhibited favorable outcomes after 1 year of follow‐up. However, lower educational attainment was linked to worse postsurgical outcomes.

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“…In the end, the surgical decision-making involves a multidisciplinary team, making team building an important element [20,58]. When it comes to the surgical intervention itself, a tandem approach has proven effective, with the experienced surgeon initially acting as primary surgeon to advise the local surgical team and care for the establishment of appropriate routines, followed by the newly introduced neurosurgeon who then performs surgery under the supervision of the experienced colleague [15,21,26,58,113].…”

Section: Training Of Local Personnel Is Mandatory and Direct Partners...mentioning

confidence: 99%

Outlines to Initiate Epilepsy Surgery in Low- and Middle-Income Countries

Bäuerle¹,

Schneider²,

Holtkamp³

et al. 2022

J. Integr. Neurosci.

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Surgery is an essential treatment option for patients with drug-resistant epilepsy. While most epilepsy patients worldwide live in low-and middle-income countries (LMIC), most of these countries do not have epilepsy surgery, and those that do have surgical epilepsy services lack capacities. The rapidly growing population in LMIC further widens the gap between the number of patients who can potentially benefit from surgery and those who can actually receive it. This makes the initiation of new surgical epilepsy centers in those countries an urgent issue. Epilepsy surgery is feasible in LMIC, even in resource-poor settings, but lack of local expertise is a major obstacle to the introduction of new surgical services. Importantly, expertise deficits can be compensated by collaborating with a well-established epilepsy center for knowledge transfer, skill building and mentoring. Such projects need to be organized in a multidisciplinary team, should focus on the given circumstances, and should use technologies and personnel that are reasonably available and can function sustainably. Local cultural factors and improvement of patients' quality of life are further spotlights reflected by an increasing number of studies. As a general outline for a new surgical epilepsy program in LMIC, it is recommended to initially focus on patients with mesial temporal lobe epilepsy due to hippocampal sclerosis or other well defined pathologies. These constellations have an excellent surgical outcome in terms of seizure control, can be diagnosed by non-invasive methods, and can be reliably identified even under low-resource conditions. Moreover, surgery can be performed with a highly standardized approach and at reasonable costs, and the vast majority of patients will benefit from surgical intervention. The range of services can then be gradually expanded, depending on growing expertise, local needs, prospects and constraints. Although the introduction of surgical epilepsy services in LMIC can face several challenges, none of them should be a permanent barrier for further establishments.

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Establishment of epilepsy surgery in Peru

Abstract: Epilepsy surgery is a well-established treatment for certain types of intractable epilepsy. While

Cited by 8 publications

References 3 publications

The humanitarian aid of neurosurgical missions in Peru: A chronicle and future perspectives

The humanitarian aid of neurosurgical missions in Peru: A chronicle and future perspectives

Postsurgical outcomes in a cohort of patients with hippocampal sclerosis: Initial experience in a referral epilepsy center in Peru

Outlines to Initiate Epilepsy Surgery in Low- and Middle-Income Countries

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