Establishment of low cost epilepsy surgery centers in resource poor setting

Jukkarwala, Anis; Baheti, Neeraj N; Dhakoji, Amit; Salgotra, Bhagwati; Menon, Girish; Gupta, Aditya; Prakash, Sanjay; Rathore, Chaturbhuj

doi:10.1016/j.seizure.2019.05.007

Cited by 15 publications

(12 citation statements)

References 19 publications

(16 reference statements)

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“…A single epilepsy center may already have a large impact in small countries such as Georgia [26], but for large countries such as India or China, a multi-tiered sys-tem of epilepsy centers with different levels of expertise is advisable [16,19,32,116]. At the most basic level, specially trained physicians would treat and care for patients with epilepsy according to standard protocols, simple centers could perform temporal lobectomy according to standardized protocols for diagnosis, assessment, and surgery, while comprehensive epilepsy surgery centers are needed for further diagnostics and more complex surgical scenarios.…”

Section: Use a Multi-tiered System To Reach Areas Outside The Large C...mentioning

confidence: 99%

“…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%

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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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Section: Use a Multi-tiered System To Reach Areas Outside The Large C...mentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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

Bäuerle¹,

Schneider²,

Holtkamp³

et al. 2022

J. Integr. Neurosci.

View full text Add to dashboard Cite

show abstract

“…

I read with interest the article by Jukkarwala et al entitled: "Establishment of low cost epilepsy surgery centers in resource poor setting" [1]. I agree with their conclusion that "It is possible to establish successful epilepsy surgery programs in resource poor setting with reasonable costs" [1]. However, I would like to suggest a strategy to reduce the costs substantially compared with their achievement of USD 1324 per patient.

…”

mentioning

confidence: 91%

Re: Establishment of low cost epilepsy surgery centers in resource poor settings

Asadi‐Pooya

2019

Seizure

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I read with interest the article by Jukkarwala et al. entitled: "Establishment of low cost epilepsy surgery centers in resource poor setting" [1]. I agree with their conclusion that "It is possible to establish successful epilepsy surgery programs in resource poor setting with reasonable costs" [1]. However, I would like to suggest a strategy to reduce the costs substantially compared with their achievement of USD 1324 per patient. In a previous review in 2008, we suggested strategies to develop epilepsy surgery centers in the developing countries [2]. We followed that strategy and established a successful epilepsy surgery program in Shiraz, Iran, in 2009 [3]. Since then, we have operated many patients with drug-resistant epilepsy with success rates comparable to the results from well-equipped and well-established western centers [4,5]. At our epilepsy surgery center in Shiraz, we can only perform daytime video-electroencephalography (EEG) monitoring for two hours. We also have 1.5 Tesla magnetic resonance imaging (MRI) with an epilepsy protocol [4]. Despite all shortcomings, we have been able to offer epilepsy surgery to many patients, who needed it, based upon the accurate identification of good surgical candidates and without jeopardizing their safety. This has resulted in total costs of outpatient assessments, inpatient assessments (presurgical evaluations) and operation to be less than $500 at our center [3]. Detection of ideal candidates for epilepsy surgery is possible for well-trained epileptologists with the help of basic investigative technologies (i.e., short-term EEG monitoring and MRI). Patients with potentially epileptogenic, well-circumscribed brain lesions on MRI and also those with mesial temporal lobe epilepsy are reasonable candidates for surgery [4]. In addition, palliative epilepsy surgeries including corpus callosotomy are also doable in these settings 5]. These kind of epilepsy surgeries are feasible in developing countries if they have a knowledgeable team consisting of an epileptologist, neurosurgeon and technicians and with using MRI and EEG as the basic investigative technologies [2]. This strategy has proven to be effective and cost saving.

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“…Despite the obvious benefits of neurosurgical intervention, there is a widely recognized surgical treatment gap [14], particularly in low-and middle-income countries lacking the appropriate specialization. Consequently, MTLE patients with a clear-cut surgical recommendation and excellent outcome prognosis accumulate in these countries, even though those patients could be identified appropriately within a limited resource setting [15]. In addition, emerging economies like Argentina [16], Colombia [17], India [15,18], Lebanon [19], Panama [20] or Tunisia [21] report seizure freedom rates after surgical resection comparable to that of high-income countries [22].…”

Section: Introductionmentioning

confidence: 99%

“…Consequently, MTLE patients with a clear-cut surgical recommendation and excellent outcome prognosis accumulate in these countries, even though those patients could be identified appropriately within a limited resource setting [15]. In addition, emerging economies like Argentina [16], Colombia [17], India [15,18], Lebanon [19], Panama [20] or Tunisia [21] report seizure freedom rates after surgical resection comparable to that of high-income countries [22]. Similar results can be achieved even in low-resource settings, as reported for Uganda [23].…”

Section: Introductionmentioning

confidence: 99%