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

Abstract

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.

Outcomes of resective surgery in pediatric patients with drug‐resistant epilepsy: A single‐center study from the Eastern Mediterranean Region

“…These include the lack of comprehensive epilepsy centers, adequate expertise, and the advanced diagnostic tools needed for thorough presurgical evaluation and intracranial monitoring. Other causes include delays in referrals from community practitioners and secondary care hospitals, socioeconomic disparities, the high cost of surgery, patient perspectives and misconceptions of the risks and benefits of surgery, and insufficient research 32–37 . As suggested in previous literature, the following measures could be taken in the EMR region to overcome these barriers.…”

“…Surgical centers should collaborate with international partners and well‐established epilepsy centers to exchange knowledge and to provide healthcare professionals with skills training and mentorship. More epilepsy centers should be developed where there is a need, and increased research funding should be allocated to epilepsy 37–40 …”

“…Other causes include delays in referrals from community practitioners and secondary care hospitals, socioeconomic disparities, the high cost of surgery, patient perspectives and misconceptions of the risks and benefits of surgery, and insufficient research. [32][33][34][35][36][37] As suggested in previous literature, the following measures could be taken in the EMR region to overcome these barriers. First, more education on the efficacy of epilepsy surgery is needed, and patients should be referred to comprehensive epilepsy programs early enough.…”

“…More epilepsy centers should be developed where there is a need, and increased research funding should be allocated to epilepsy. [37][38][39][40] Despite many challenges, we were able to obtain ABRET accreditation for our EMU, and we have advanced in the area of epilepsy surgery over the last decade. We now perform lesionectomies, multilobar resections, hemispherotomies, corpus callosotomies, subdural grid monitoring, SEEG monitoring, intra-and extra-operative motor and language mapping, 41 and cortical stimulation.…”

The Love Hormone and Seizure Control: A Review of Oxytocin’s Impact on Epilepsy Management

“…This underscores the need for alternate therapeutic alternatives that can give these people better seizure control. Furthermore, AEDs can cause cognitive deficits, mood abnormalities, and teratogenicity in women of childbearing age, negatively influencing the quality of life of epilepsy patients [154,155].…”