Missed opportunities for epilepsy surgery referrals in Bhutan: A cohort study

Ham, Andrew Siyoon; Nirola, Damber Kumar; Ayub, Neishay; Tshering, Lhab; Dem, Ugyen; Dorji, Chencho; Mateen, Farrah J.

doi:10.1016/j.eplepsyres.2019.106252

Cited by 5 publications

(2 citation statements)

References 23 publications

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“…While the utilization of epilepsy surgery seems to be on an upward trend in these three countries, it is important to note the gross under‐representation of other LMICs particularly in Africa. Strategies to address these inequities should focus not only on supporting investments in infrastructure and expertise, but also ensure better referral 27,34 and promote judicious utilization of resources 35 …”

Section: Discussionmentioning

confidence: 99%

Trends in pediatric epilepsy surgery: A lower‐middle‐income country perspective

et al. 2021

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Objective To study the trends for pediatric epilepsy surgery between 2000 and 2014 in a tertiary epilepsy surgery center in India in order to gain a lower‐ and middle‐income country (LMIC) perspective. Methods Children aged <18 years and undergoing epilepsy surgery were divided into three groups based on the year that they underwent surgery—group 1: year 2000–2004; group 2: year 2005–2009; and group 3: year 2010–2014. Data including the rate of surgery, type of surgery, and duration of epilepsy before referral were analyzed from the medical records and compared. Results Between 2000 and 2014, 463 pediatric epilepsy surgeries were performed. The proportion of pediatric epilepsy surgeries showed an increasing trend—218 (total 510 surgeries, 42.74%) in group 3, compared with 115 (total 375 surgeries, 30.66%) in group 1 and 130 (total 466 surgeries, 27.9%) in group 2. A significant decrease in the age at evaluation and duration of epilepsy before referral was noted between 2000 and 2014, particularly in patients belonging to the lowest income group. There was a two‐fold increase in the number of extratemporal surgeries over time. The proportion of children undergoing surgery for benign tumors, cortical malformations, and gliosis/atrophy showed an upward trend while that for mesial temporal sclerosis did not show an increase. Significance Promising trends in pediatric epilepsy surgery were noted with increasing number of surgeries and decreasing age at presurgical evaluation. Seen from an LMIC perspective, this reflects an evolution in the practice of pediatric epilepsy surgery, mirroring trends in high‐income countries.

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Section: Discussionmentioning

confidence: 99%

Trends in pediatric epilepsy surgery: A lower‐middle‐income country perspective

et al. 2021

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“…A recent survey for Africa [11] found that epilepsy surgery is performed in only 8 out of 51 countries, with only one country reporting invasive presurgical diagnostics. As a consequence, clear-cut cases with excellent outcome prognosis, such as patients with mesial temporal lobe epilepsy (MTLE) with hippocampal sclerosis (HS), accumulate in LMIC [12][13][14], even though the establishment of low-cost epilepsy surgery programs is feasible in countries with resource-poor settings [15,16]. Furthermore, with a rapidly growing population in LMIC, the gap between the number of patients who could benefit from surgical intervention and those who can actually receive it is widening yearly [11], making the initiation of surgical epilepsy services for those countries a timely issue.…”

Section: Introductionmentioning

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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