Epilepsy surgery in Africa: state of the art and challenges

Kissani, Najib; Nafia, Sanaa; Khiat, Abdelaati El; Bengamara, Noureddine; Maiga, Youssoufa; Sogoba, Youssouf; Ibrahim, Eetedal Ahmed A.; Agbétou, Mendinatou; Daniel, Gams Massi; Assogba, Komi; Gaye, Ndiaga Matar; Tegueu, Callixte Kuate; Ragab, Amany; Razafimahefa, Julien; Wilmshurst, Jo M.; Naidoo, Ansuya; Jabang, John N.; Watila, Musa Mamman

doi:10.1016/j.yebeh.2021.107910

Cited by 13 publications

(18 citation statements)

References 26 publications

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“…By 1) training MRI radiographers to master acquisition of these advanced techniques and adapt parameters from research to their lower-field strength systems, 2) training MRI physicist to analyze images from their lower quality scanners leveraging on machine learning, 3) training biomedical engineers and physicists to build brain coils compatible with reconfigured and legacy systems to increase the spatial resolution, and 4) upskilling radiologists to read these novel MRI techniques, epilepsy surgical patients in SSA, may expect to have similar outcomes to their peers in the rest of the world. Until then, these African patients – ∼303,000/year 44 , will continue to suffer tractable epilepsy without any access to successful treatment. Similar remarks can be made for cancer, stroke, and cardiac imaging, as well research studies particularly in dementia and mental health where functional and molecular imaging biomarkers are highly sought after but underdeveloped in MRI scanners typically available in Sub-Saharan Africa.…”

Section: Discussionmentioning

confidence: 99%

“…Improving training and research collaboration in SSA, will advance the use of MRI technology in the region to find relevant solutions to imaging needs, especially in the absence of 'luxury suite' imaging (e.g PET, MEG, high-density EEG) 3,27 . For instance, epilepsy disproportionately impacts SSA (10x higher incidence compared to high-income countries) 44 , and up to 30% of epilepsy patients require surgery to resect brain lesions to alleviate seizures. Anatomical brain MRI performed as standard of care to localize the lesion for surgery, appears normal in one-third of these patients and luxury suite imaging using PET or MEG and high-density EEG are functionally used to localize lesion(s) 45 .…”

Section: Anticipated Impactmentioning

confidence: 99%

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A Framework for Advancing Sustainable MRI Access in Africa

Anazodo

Ehiogu

et al. 2022

Preprint

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MRI technology has profoundly transformed current healthcare and research systems globally. The rapidly growing burden of non-communicable diseases in Africa has underscored the importance of improving access to MRI equipment as well as training and research opportunities on the continent. The Consortium for Advancement of MRI Education & Research in Africa (CAMERA) is a network of African experts, global partners, and ISMRM/ESMRMB members implementing novel strategies to advance MRI access and research in Africa. To identify challenges to MRI usage and provide a framework for addressing MRI needs in the region, CAMERA conducted a Needs Assessment Survey (NAS) and a series of symposia at international MRI society meetings over a 2-year period. The 68-question NAS was distributed to MRI users in Africa and completed by 157 clinicians and scientists from across Sub-Saharan Africa (SSA). On average, the number of MRI scanners per million people remained at <1, of which, 39% were obsolete low-field systems yet still in use to meet clinical needs. The feasibility of coupling stable energy supplies from various sources has contributed to the growing number of higher-field (1.5T) MRI scanners in the region. However, these systems are underutilized with only 8% of facilities reporting clinical scans of 15 or more patients daily per scanner. The most frequently reported MRI scans were neurological and musculoskeletal. Our NAS combined with the World Health Organization and International Atomic Energy Agency data provides the most up-to-date data on MRI density in Africa and offers unique insight into Africa's MRI needs. Reported gaps in training, maintenance, and research capacity indicate ongoing challenges in providing sustainable high-value MRI access in SSA. Findings from the NAS and focused discussions at ISMRM and ESMRMB provided the basis for the framework presented here for advancing MRI capacity in SSA.

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Section: Discussionmentioning

confidence: 99%

Section: Anticipated Impactmentioning

confidence: 99%

A Framework for Advancing Sustainable MRI Access in Africa

Anazodo

Ehiogu

et al. 2022

Preprint

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“…Surgery is a cost-efficient treatment for DRE in terms of long-term direct, indirect and intangible costs [45,[147][148][149], making it an essential component of a comprehensive therapeutic approach to epilepsy [17,150]. It should be noted that the median epilepsy prevalence and incidence in LMIC may be almost twice that in HIC [151], with even higher rates for the lowest-income countries (e.g., incidence may be 10-fold higher than in HIC [11]) and proportional numbers of drug-resistant variants. While the number of MTLE-HS surgeries in European epilepsy centers has decreased in recent decades thanks to ongoing efforts including therapy and surgery [42,[152][153][154], MTLE-HS patients still accumulate in LMIC without surgical epilepsy services.…”

Section: Healthcare System and Economic Constraintsmentioning

confidence: 99%

“…In the ASEAN countries, for example, epilepsy surgery is underutilized due to a lack of surgical epilepsy centers and appropriately trained personal [10]. 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].…”

Section: Introductionmentioning

confidence: 99%

“…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. While there appears to be broad consensus on the basis for establishing such programs, as outlined in several early publications [17][18][19][20][21][22][23][24], subsequent reports have emphasized additional aspects, substantiated former claims and set out new spotlights.…”

Section: Introductionmentioning

confidence: 99%

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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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Unlocking the hidden burden of epilepsy in Africa: Understanding the challenges and harnessing opportunities for improved care

Aderinto

2023

Health Science Reports

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Background: Epilepsy is a common neurological disorder that affects many people in Africa, yet the burden of the disease is often hidden. The management of epilepsy in Africa is often inadequate due to a lack of awareness and education, limited access to diagnostic tools and treatments, inadequate coordination of care, and the stigma associated with the condition.Method: A comprehensive literature review was conducted to gather information on the epidemiology, diagnosis, management, and outcomes of epilepsy in Africa. The review included studies from peer-reviewed journals, government reports, and gray literature. Results:The review revealed a high burden of epilepsy in Africa. The studies also showed a significant gap in the availability and accessibility of diagnostic tools, antiepileptic drugs, and specialized therapies such as physical, occupational, and speech therapy. Additionally, the review found that cultural beliefs and practices, socioeconomic factors such as poverty and lack of access to healthcare, and the stigma associated with the condition, also pose significant challenges to managing epilepsy in Africa. Conclusion:The study highlights the urgent need for improved epilepsy management in Africa. Additionally, the study calls for further research on epilepsy in Africa and collaboration between all stakeholders to improve the management of epilepsy in Africa.

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Epilepsy surgery in Africa: state of the art and challenges

Cited by 13 publications

References 26 publications

A Framework for Advancing Sustainable MRI Access in Africa

A Framework for Advancing Sustainable MRI Access in Africa

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

Unlocking the hidden burden of epilepsy in Africa: Understanding the challenges and harnessing opportunities for improved care

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