Temporal Lobe Epilepsy Surgery with Limited Resources: Results and Economic Considerations

Abstract

Summary: This study evaluates the surgical outcome of patients with medically refractory temporal lobe epilepsy (TLE) who underwent anterior temporal lobe lobectomy (ATL) based on data derived from noninvasive studies and assesses the economic costs entailed at a newly created epilepsy program in Chile. Seventeen ATL candidates underwent a presurgical evaluation. This included outpatient brain MRI and neuropsychological testing and inpatient scalp/sphenoidal prolonged video-EEG monitoring. There were 10 females and 7 males, with a mean age of 23.8 years and a mean duration of seizure disorder of 12 years. Patients with congruent data localizing the seizure focus to one anterotemporal region underwent ATL. Seven patients underwent a left-side ATL and 10 patients a right-side ATL. The histopathological findings showed a lowgrade tumor in six patients, hippocampal sclerosis in five, neuronal migration disorder in four, and cavernous angiomas in two patients. The mean follow-up period was 29.1 months. Seizure outcome was assessed with Engel's classification: class I, no seizures or only auras; class 11, rare seizures; class 111, >90% seizure reduction; class IV, <90% seizure reduction. Fifteen patients are now in class I, one patient in class 11, and one in class IV. The total cost, including evaluation and surgery, was equivalent to US$ 5,020. Thus, well-selected TLE patients can derive maximal benefit from ATL after a noninvasive presurgical evaluation. This finding is of great significance for the creation of epilepsy surgery programs in developing countries.

Establishment of a Comprehensive Epilepsy Center in Pakistan: Initial Experiences, Results, and Reflections

“…In the year 2000, a study came from Chile reporting a total cost of US$ 5,020 including preoperative evaluation and surgery for an anterior temporal lobectomy (ATL) [23]. Similar paper came from neighboring country India in which the total direct cost of US$ 5000 was reported for an ATL.…”

Perspectives of epilepsy surgery in resource-poor countries: a study in Georgia

“…We also estimated the probability of being seizure-free 1 year after surgical treatment based on publications where authors defined expected outcomes according to various combinations of predictors [1,7,16,17,23,31]. This data was then applied to cases in our study and the approximate chance of seizure freedom was estimated.…”

“…Estimated probability of 1-year seizure freedom according to various level of concordance between clinical, EEG, and MRI findings (references for estimations below[1,7,16,17,23,31])…”

Strategies for surgical treatment of epilepsies in developing countries

“…If hippocampal abnormalities on MRI are clearly unilateral and history, semiology of seizures (e.g., ability to warn at seizure onset, digestive auras including rising epigastric aura, alteration of consciousness, early oroalimentary automatisms, postictal amnesia, etc. ), and EEG findings are concordant, these patients are excellent candidates for anterior temporal lobectomy without additional testing (Campos et al, 2000;Ozkara et al, 2000;Williamson & Jobst, 2000;Butler, 2005). Patients with MTLE and consistent findings based on interictal scalp EEG and MRI may not even require ictal video-EEG recording (Cherian & Radhakrishnan, 2002).…”