Surgery for Radiologically Normal-Appearing Temporal Lobe Epilepsy in a Centre with Limited Resources

Arifin, Muhamad Thohar; Bakhtiar, Yuriz; Andar, Erie Bps; B., Happy Kurnia; Priambada, Dody; Risdianto, Ajid; Kusnarto, Gunadi; Tsaniadi, Krisna; Bunyamin, Jacob; Hanaya, Ryosuke; Arita, Kazunori; Bintoro, Aris Catur; Iida, Koji; Kurisu, Kaoru; Askoro, Rofat; Briliantika, Surya P.; Muttaqin, Zainal

doi:10.1038/s41598-020-64968-4

Cited by 3 publications

(3 citation statements)

References 23 publications

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“…This report presented long-term outcomes of a large cohort of epilepsy patients who underwent surgery (589 people) with at least 2 years of follow-up, covering nearly three seizure-free quarters. In addition, this report strengthened our previous study epilepsy surgeries conducted in Indonesia, the most populous country in Southeast Asia 8 . Previous authors have described the establishment of this surgical service as feasible and cost-effective in other developing countries, including India, Lebanon, and Colombia, with comparable outcomes to those in developed countries 9 – 14 .…”

Section: Discussionsupporting

confidence: 87%

Initiating an epilepsy surgery program with limited resources in Indonesia

Arifin

Hanaya

Bakhtiar

et al. 2021

Sci Rep

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To share the experiences of organizing the epilepsy surgery program in Indonesia. This study was divided into two periods based on the presurgical evaluation method: the first period (1999–2004), when interictal electroencephalogram (EEG) and magnetic resonance imaging (MRI) were used mainly for confirmation, and the second period (2005–2017), when long-term non-invasive and invasive video-EEG was involved in the evaluation. Long-term outcomes were recorded up to December 2019 based on the Engel scale. All 65 surgical recruits in the first period possessed temporal lobe epilepsy (TLE), while 524 patients were treated in the second period. In the first period, 76.8%, 16.1%, and 7.1% of patients with TLE achieved Classes I, II, and III, respectively, and in the second period, 89.4%, 5.5%, and 4.9% achieved Classes I, II, and III, respectively, alongside Class IV, at 0.3%. The overall median survival times for patients with focal impaired awareness seizures (FIAS), focal to bilateral tonic–clonic seizures and generalized tonic–clonic seizures were 9, 11 and 11 years (95% CI: 8.170–9.830, 10.170–11.830, and 7.265–14.735), respectively, with p = 0.04. The utilization of stringent and selective criteria to reserve surgeries is important for a successful epilepsy program with limited resources.

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Section: Discussionsupporting

confidence: 87%

Initiating an epilepsy surgery program with limited resources in Indonesia

Arifin

Hanaya

Bakhtiar

et al. 2021

Sci Rep

Self Cite

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“…Approximately 66% of seizure patients can be successfully treated with medications, while in cases of mesial TLE surgery is recommended. 44 Borbély et al evaluated the clinical impact of hybrid [ 18 F]-FDG PET/MRI imaging on the detection of epilepsy in patients and reported its clinical significance. 45 Zhao et al mentioned in their review on TLE that it affects primarily cognitive functions related to memory, language and social judgment, so it is essential to detect its occurrence and cause timely and accurately since this condition affects the mental well-being of a patient and can disturb their social life.…”

Section: Discussionmentioning

confidence: 99%

A meta-analysis to investigate the role of magnetic resonance spectroscopy in the detection of temporal lobe epilepsy

Cui¹,

Zhong²,

Zheng³

2022

Adv Clin Exp Med

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Background. Temporal lobe epilepsy (TLE) is a complex neuropsychiatric illness that alters patient's behavior and social well-being. Early and accurate diagnosis of TLE is a key factor in its treatment. Currently, magnetic resonance spectroscopy (MRS) is recommended due to its high sensitivity and specificity in the detection of seizures. However, some studies have reported on its limited role in lesion detection.Objectives. The present meta-analysis aims to analyze different studies thoroughly and investigate the role of MRS in the detection of TLE. Materials and methods.A systematic literature review was conducted using Medline (via PubMed), Cinahl (via EBSCO), Scopus, and Web of Sciences databases for case-control, retrospective and prospective studies regarding the use of MRS in detecting TLE. Studies were included using the Population, Intervention, Comparison, Outcomes and Study (PICOS) criteria and relevant event data were extracted. The risk of publication bias was analyzed using the Begg and Mazumdar test. A risk of bias assessment was conducted using RevMan software. The Mantel-Haenszel method was used to calculate the sensitivity, pooled odds ratio (OR), and risk ratio (RR), also using RevMan software.Results. A total of 16 studies published between 2000 and 2022 were included, which encompassed a total of 645 patients. We obtained a high sensitivity of 84.8%, which shows a high efficiency of MRS, and a pooled OR value of 0.37 (95% confidence interval (95% CI): 0. 14-0.97) with a tau 2 value of 2.63, χ 2 value of 84.99, degrees of freedom (df) value of 15, I 2 value of 82%, Z-value of 2.03, and p < 0.05. The pooled RR was 0.82 (95% CI: 0.69-0.97) with a tau 2 value of 0. 10, χ 2 value of 122. 11, df of 15, I 2 value of 88%, Z-value of 2.25, and p < 0.05. These results were statistically significant for a low risk of publication bias.Conclusions. The current meta-analysis highly recommends the use of MRS in the accurate detection of alterations seen in the brain in patients with TLE.

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“…Subsequently, the spectrum was expanded with the introduction of subdural electrode recordings, long-term EEG and PET examination for difficult cases. Selective amygdalohippocampectomy and the treatment of extratemporal lobe epilepsy were introduced [58] and the center was enabled to perform surgery for radiologically normal appearing temporal lobe epilepsy patients [118]. The evolution of a center in this sense means that more and more complex investigative and surgical procedures are added [19,116], while a major challenge for such a development often lies in the paucity or resources [32,118].…”

Section: The Stepwise Approach: Evolution Of Surgical Epilepsy Centersmentioning

confidence: 99%

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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Surgery for Radiologically Normal-Appearing Temporal Lobe Epilepsy in a Centre with Limited Resources

Cited by 3 publications

References 23 publications

Initiating an epilepsy surgery program with limited resources in Indonesia

Initiating an epilepsy surgery program with limited resources in Indonesia

A meta-analysis to investigate the role of magnetic resonance spectroscopy in the detection of temporal lobe epilepsy

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

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