Epilepsy surgery in a developing country (Lebanon): ten years experience and predictors of outcome

Mikati, Mohamad A.; Ataya, Nour; El-Ferezli, Jessica C; Shamseddine, A.; Rahi, Amal C.; Herlopian, Aline; Kurdi, Rana; Bhar, Saleh; Hani, Abeer J.; Comair, Youssef G.

doi:10.1684/epd.2012.0522

Cited by 19 publications

(10 citation statements)

References 34 publications

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“…Other LMICs have introduced surgical treatment for DRE with varying degrees of success (Campos, 2012; Kasradze et al, 2015; Mikati et al, 2012). Unfortunately, surgical treatment for epilepsy is not available in Bhutan.…”

Section: Discussionmentioning

confidence: 99%

Yield of Brain MRI in Clinically Diagnosed Epilepsy in the Kingdom of Bhutan: A Prospective Study

Bruno

Klein

Nidup³

et al. 2017

Annals of Global Health

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Introduction To report the diagnostic yield of brain MRI and identify clinical associations of abnormal MRI findings among people with epilepsy (PWE) in a neurocysticercosis-endemic, resource-limited setting, and to identify the proportion and putative structural brain causes of drug resistant epilepsy cases. Methods PWE were prospectively enrolled at the Jigme Dorji Wangchuck National Referral Hospital in Bhutan (2014–2015). Each participant completed clinical questionnaires and a 1.5 tesla brain MRI. Each MRI was reviewed by at least one radiologist and neurologist in Bhutan and the U.S.A. A working definition of drug resistant epilepsy for resource-limited settings was given as (a) seizures for >1 year, (b) at least one seizure in the prior year, and (c) presently taking 2 or more antiepileptic drugs (AEDs). Logistic regression models were constructed to test the cross-sectional association of an abnormal brain MRI with clinical variables. Results 217 participants [125 (57%) female; 54 (25%) <18 years old; 199 (92%) taking AEDs; 154 (71%) with a seizure in the prior year] were enrolled. There was a high prevalence of abnormal brain MRIs (176/217, 81%). Mesial temporal sclerosis was the most common finding (n=115, 53%, including 24 children), exceeding the number of PWE with neurocysticercosis (n=26, 12%, including one child) and congenital/perinatal abnormalities (n=29, 14%, including 14 children). The number of AEDs (odds ratio=0.59, p=0.03) and duration of epilepsy (odds ratio=1.11, p=0.02) were significantly associated with an abnormal MRI. Seizure in the prior month was associated with the presence of mesial temporal sclerosis (odds ratio=0.47, p=0.01). 25 (12%) participants met our definition of drug resistant epilepsy with mesial temporal sclerosis (n=10), congenital malformations (n=5), and neurocysticercosis (n=4) being the more frequent findings. Conclusions The prevalence of abnormalities on brain MRI for PWE in resource-limited settings is high due to a diffuse range of etiologies, most commonly mesial temporal sclerosis. Drug resistant epilepsy accounted for 12% of the referral population in a conservative estimation.

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Section: Discussionmentioning

confidence: 99%

Yield of Brain MRI in Clinically Diagnosed Epilepsy in the Kingdom of Bhutan: A Prospective Study

Bruno

Klein

Nidup³

et al. 2017

Annals of Global Health

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“…Surgical outcome has conceptually evolved and expanded over time to consider developmental, social, cognitive, psychological, and behavioral factors. Despite the acknowledged importance of these other factors in surgical outcome, most outcome studies continue to emphasize seizure-related factors (11–13). Few studies have evaluated behavioral and emotional outcome following pediatric epilepsy surgery.…”

Section: Introductionmentioning

confidence: 99%

Effects of Surgical Side and Site on Mood and Behavior Outcome in Children with Pharmacoresistant Epilepsy

et al. 2014

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Children with epilepsy have a high rate of mood and behavior problems; yet few studies consider the emotional and behavioral impact of surgery. No study to date has been sufficiently powered to investigate effects of both side (left/right) and site (temporal/frontal) of surgery. One hundred patients (aged 6–16) and their families completed measures of depression, anxiety, and behavioral function as part of neuropsychological evaluations before and after surgery for pharmacoresistant epilepsy. Among children who had left-sided surgeries (frontal = 16; temporal = 38), there were significant interactions between time (pre to post-operative neuropsychological assessment) and resection site (frontal/temporal) on anhedonia, social anxiety, and withdrawn/depressed scales. Patients with frontal lobe epilepsy (FLE) endorsed greater pre-surgical anhedonia and social anxiety than patients with temporal lobe epilepsy (TLE) with scores normalizing following surgery. While scores on the withdrawn/depressed scale were similar between groups before surgery, the FLE group showed greater symptom improvement after surgery. In children who underwent right-sided surgeries (FLE = 20; TLE = 26), main effects of time (patients in both groups improved) and resection site (caregivers of FLE patients endorsed greater symptoms than those with TLE) were observed primarily on behavior scales. Individual data revealed that a greater proportion of children with left FLE demonstrated clinically significant improvements in anhedonia, social anxiety, and aggressive behavior than children with TLE. This is the first study to demonstrate differential effects of both side and site of surgery in children with epilepsy at group and individual levels. Results suggest that children with FLE have greater emotional and behavioral dysfunction before surgery, but show marked improvement after surgery. Overall, most children had good emotional and behavioral outcomes, with most scores remaining stable or improving.

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“…Mikati et al demonstrated the capacity to treat patients from a number of Middle Eastern and North African countries in Lebanon. 38 Ouazzani also reported good outcomes over a prolonged follow-up of patients in Morocco. 41 Centers like these likely have the potential to serve as regional ECEs.…”

Section: Future Directionsmentioning

confidence: 87%

“…Two studies included a notable proportion of patients treated with ATL ± AH, but both reported pooled seizure outcomes that were based on the inclusion of patients with palliative procedures as well. 29,38 These were not included in the meta-analysis.…”

Section: Pooled Seizure Outcomes For Atl ± Ahmentioning

confidence: 99%

Surgical outcomes for medically intractable epilepsy in low- and middle-income countries: a systematic review and meta-analysis

Mansouri

Taslimi²,

Abbasian

et al. 2019

Journal of Neurosurgery

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OBJECTIVEThe aim of this study was to describe the current state of epilepsy surgery and establish estimates of seizure outcomes following surgery for medically intractable epilepsy (MIE) in low- and middle-income countries (LMICs).METHODSThe MEDLINE and Embase databases were searched without publication date restriction. This search was supplemented by a manual screen of key epilepsy and neurosurgical journals (January 2005 to December 2016). Studies that reported outcomes for at least 10 patients of any age undergoing surgery for MIE in LMICs over a defined follow-up period were included. A meta-analysis with a random-effects model was performed in accordance with the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) statement and MOOSE (Meta-analysis of Observational Studies in Epidemiology) guidelines. Pooled estimates of seizure freedom and favorable seizure outcomes following anterior temporal lobectomy with or without amygdalohippocampectomy (ATL ± AH) were reported.RESULTSTwenty studies were selected, of which 16 were from Asian centers. The average age at surgery in all studies was less than 30 years, and the average preoperative duration of epilepsy ranged from 3 to 16.1 years. Mesial temporal sclerosis accounted for 437 of 951 described pathologies, and 1294 of the 1773 procedures were ATL ± AH. Based on 7 studies (646 patients) the pooled seizure freedom estimate following ATL ± AH was 68% (95% CI 55%–82%). Based on 8 studies (1096 patients), the pooled estimate for favorable seizure outcomes was 79% (95% CI 74%–85%).CONCLUSIONSSurgery for MIE in LMICs shows a high percentage of seizure freedom and favorable outcomes. These findings call for a concerted global effort to improve timely access to surgery for MIE patients in these regions, including investments aimed at refining existing and establishing additional centers.

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Epilepsy surgery in a developing country (Lebanon): ten years experience and predictors of outcome

Cited by 19 publications

References 34 publications

Yield of Brain MRI in Clinically Diagnosed Epilepsy in the Kingdom of Bhutan: A Prospective Study

Yield of Brain MRI in Clinically Diagnosed Epilepsy in the Kingdom of Bhutan: A Prospective Study

Effects of Surgical Side and Site on Mood and Behavior Outcome in Children with Pharmacoresistant Epilepsy

Surgical outcomes for medically intractable epilepsy in low- and middle-income countries: a systematic review and meta-analysis

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