Initiating a new national epilepsy surgery program: Experiences gathered in Georgia

Dugladze, Tamar; Bäuerle, Peter; Kasradze, Sofia; Lomidze, Giorgi; Gzirishvili, Nino; Tsikarishvili, Vladimir; Khurtsidze, Gregory; Vida, Imre; Schmitz, Dietmar; Schneider, Ulf C.; Holtkamp, Martin; Gloveli, Tengis

doi:10.1016/j.yebeh.2020.107259

Cited by 3 publications

(9 citation statements)

References 47 publications

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“…Such expensive state-of-the-art equipment may not be feasible for local surgical epilepsy centers in LMIC, so cost-effective methods are crucial [15] and low-cost options should be used first. For example, further diagnostics to clarify a suspected bilateral epileptic focus can be carried out with subdural or depth EEG recordings, but also with foramen ovale electrode recordings [26]. This tech-nique is less demanding, minimally invasive, and less expensive compared with subdural or depth EEG recordings, but also provides an effective way to assess lateralization of the seizure focus in MTLE patients [68].…”

Section: Invasive Diagnosticsmentioning

confidence: 99%

“…Thus, if a surgical epilepsy program should have a lasting impact, in addition to building on locally available technology, training of local professionals is critical, and the project has to create appropriate educational opportunities [23]. This could include visits by established experts to local facilities, accompanied by local training units [26], to provide knowledge transfer, advice and consultation. It is a valuable tool to initiate direct partnerships between individual professionals and to carry out professionspecific training and knowledge transfer.…”

Section: Training Of Local Personnel Is Mandatory and Direct Partners...mentioning

confidence: 99%

“…In the end, the surgical decision-making involves a multidisciplinary team, making team building an important element [20,58]. When it comes to the surgical intervention itself, a tandem approach has proven effective, with the experienced surgeon initially acting as primary surgeon to advise the local surgical team and care for the establishment of appropriate routines, followed by the newly introduced neurosurgeon who then performs surgery under the supervision of the experienced colleague [15,21,26,58,113].…”

Section: Training Of Local Personnel Is Mandatory and Direct Partners...mentioning

confidence: 99%

“…In general, time abroad can be spent in a single block (e.g., Boling W, et al [15]) or in multiple units (e.g., Dugladze, et al [26]), but time is a valuable resource, in particular for clinicians beneficially participating in a mentoring program. Hence, the essential time for a stay abroad should be carefully considered.…”

Section: Electronic Communication and Time Managementmentioning

confidence: 99%

“…It is our aim to briefly summarize the established basics and highlight new building blocks and key aspects in light of recent publications. This endeavor was triggered by our own experience [25,26]. In this regard, it is also a personal view that draws on the growing literature to discuss barriers and challenges, in order to propose a framework for building of such a surgical program.…”

Section: Introductionmentioning

confidence: 99%

See 4 more Smart Citations

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: Invasive Diagnosticsmentioning

confidence: 99%

Section: Training Of Local Personnel Is Mandatory and Direct Partners...mentioning

confidence: 99%