Underutilization of epilepsy surgery in ASEAN countries

Le, Minh‐An Thuy; Fong, Si‐Lei; Lim, Kheng‐Seang; Gunadharma, Suryani; Sejahtera, Desin Pambudi; Visudtibhan, Anannit; Chan, Derrick; Vorachit, Somchit; Chan, Samleng; Ohnmar, Ohnmar; Chua, Annabell E.; Cabral‐Lim, Leonor; Yassin, Norazieda; Le, Viet‐Thang; Tan, Chee Keong

doi:10.1016/j.seizure.2019.04.002

Cited by 21 publications

(13 citation statements)

References 20 publications

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“…Consequently, there regions that were not represented (Africa, Latin America, and Southeast Asia), commensurate with areas where SEEG was currently not routinely practiced. 33 Data curation was required for pulse width where units were inaccurately reported or a range was provided, and removed for cases where input was seemingly unreasonable. The conservative approach to data management may have resulted in charge density being slightly underestimated.…”

Section: Limitationsmentioning

confidence: 99%

An international survey of SEEG cortical stimulation practices

et al. 2023

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ObjectiveCortical stimulation is an important component of stereoelectroencephalography (SEEG). Despite this, there is currently no standardized approach and significant heterogeneity in the literature regarding cortical stimulation practices. Via an international survey of SEEG clinicians, we sought to examine the spectrum of cortical stimulation practices to reveal areas of consensus and variability.MethodsA 68‐item questionnaire was developed to understand cortical stimulation practices including neurostimulation parameters, interpretation of epileptogenicity, functional and cognitive assessment and subsequent surgical decisions. Multiple recruitment pathways were pursued, with the questionnaire distributed directly to 183 clinicians.ResultsResponses were received from 56 clinicians across 17 countries with experience ranging from 2 to 60 years (M = 10.73, SD = 9.44). Neurostimulation parameters varied considerably, with maximum current ranging from 3 to 10 mA (M = 5.33, SD = 2.29) for 1 Hz and from 2 to 15 mA (M = 6.54, SD = 3.68) for 50 Hz stimulation. Charge density ranged from 8 to 200 μC/cm2, with up to 43% of responders utilizing charge densities higher than recommended upper safety limits, i.e. 55 μC/cm2. North American responders reported statistically significant higher maximum current (P < 0.001) for 1 Hz stimulation and lower pulse width for 1 and 50 Hz stimulation (P = 0.008, P < 0.001, respectively) compared to European responders. All clinicians evaluated language, speech, and motor function during cortical stimulation; in contrast, 42% assessed visuospatial or visual function, 29% memory, and 13% executive function. Striking differences were reported in approaches to assessment, classification of positive sites, and surgical decisions guided by cortical stimulation. Patterns of consistency were observed for interpretation of the localizing capacity of stimulated electroclinical seizures and auras, with habitual electroclinical seizures induced by 1 Hz stimulation considered the most localizing.SignificanceSEEG cortical stimulation practices differed vastly across clinicians internationally, highlighting the need for consensus‐based clinical guidelines. In particular, an internationally standardized approach to assessment, classification, and functional prognostication will provide a common clinical and research framework for optimizing outcomes for people with drug‐resistant epilepsy.

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Section: Limitationsmentioning

confidence: 99%

An international survey of SEEG cortical stimulation practices

et al. 2023

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“…10 In the 11 countries (Indonesia, Philippines, Vietnam, Thailand, Myanmar, Malaysia, Cambodia, Laos, Singapore, East Timor, and Brunei) of the Association of Southeast Asian Nations (ASEAN), there were 42 epilepsy centers serving 640 million people in 2018. 11 Korea had 14 centers for 48 million people. 11 Although the years of the data were different, China and Korea had approximately the same per capita number of epilepsy centers, which was higher than that of ASEAN countries and lower than that of the United States.…”

Section: F I G U R Ementioning

confidence: 99%

“…11 Korea had 14 centers for 48 million people. 11 Although the years of the data were different, China and Korea had approximately the same per capita number of epilepsy centers, which was higher than that of ASEAN countries and lower than that of the United States.…”

Section: F I G U R Ementioning

confidence: 99%

Epilepsy centers in China: Current status and ways forward

Lin

Hao

et al. 2021

Epilepsia

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China has the largest population of patients with epilepsy worldwide, which imposes a heavy burden on the public and health care systems. Several epidemiological surveys on epilepsy have been performed in China. Although these surveys grossly describe the prevalence and gap in treatment of epilepsy, the status of epilepsy centers is unclear. The number of epilepsy centers has increased substantially in recent decades. Therefore, a nationwide investigation of the scale and distribution, personnel, equipment, and epilepsy care capacity of each epilepsy center is of great value. Methods: In 2017-2018, a multicenter cross-sectional survey was performed by the Commission on Standardized Development of Epilepsy Centers, China Association Against Epilepsy in 31 provinces, autonomous regions, and municipalities. The survey consisted of 74 questions divided into four sections: (1)

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“…8 A recent cross-sectional survey study in ASEAN countries showed that epilepsy surgery is severely underutilized, and concluded that lack of expertise, epilepsy centers, and funding contribute to this underutilization. 9 Due to the lack of reports on the utilization and outcome of epilepsy surgery, especially in pediatric patients in the Eastern Mediterranean Region, this retrospective study examines the outcomes of resective surgery in pediatric patients with DRE.…”

Section: Introductionmentioning

confidence: 99%

“…Despite the favorable outcome, epilepsy surgery is still underutilized globally, including in the developed nations 8 . A recent cross‐sectional survey study in ASEAN countries showed that epilepsy surgery is severely underutilized, and concluded that lack of expertise, epilepsy centers, and funding contribute to this underutilization 9 …”

Section: Introductionmentioning

confidence: 99%

Outcomes of resective surgery in pediatric patients with drug‐resistant epilepsy: A single‐center study from the Eastern Mediterranean Region

Mir,

Jallul,

Alotaibi

et al. 2023

Epilepsia Open

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ObjectiveEpilepsy surgery is widely accepted as an effective therapeutic option for carefully selected patients with drug‐resistant epilepsy (DRE). There is limited data on the outcome of epilepsy surgery, especially in pediatric patients from the Eastern Mediterranean region. Hence, we performed a retrospective study examining the outcomes of resective surgery in 53 pediatric patients with focal DRE.MethodsPatients with focal DRE who had undergone epilepsy surgery were included in the present study. All patients underwent a comprehensive presurgical evaluation. Postoperative seizure outcomes were classified using the Engel Epilepsy Surgery Outcome Scale.ResultsAfter surgery, 33 patients (62.2%) were Class I according to the Engel classification of surgical outcomes; eight patients (15.0%) were Class II, 11 (20.7%) were Class III, and one (1.8%) was Class IV. The relationships of presurgical, surgical, and postsurgical clinical variables to seizure outcomes were compared. Older age at seizure onset, older age at the time of surgery, the presence of focal to bilateral tonic–clonic seizures, seizure duration over 2 minutes, unsuccessful treatment with three or fewer antiseizure medications, lesions confined to one lobe (as demonstrated via magnetic resonance imaging [MRI]), surgical site in the temporal lobe, and histopathology including developmental tumors were significantly linked to an Engel Class I outcome. A univariate analysis of excellent surgical outcomes showed that lateralized semiology, localized interictal and ictal electroencephalogram (EEG) discharges, lateralized single‐photon emission computed tomography and positron emission tomography findings, and temporal lobe resections were significantly related to excellent seizure outcomes.SignificanceThe results of our study are encouraging and similar to those found in other centers around the world. Epilepsy surgery remains an underutilized treatment for children with DRE and should be offered early.

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Underutilization of epilepsy surgery in ASEAN countries

Cited by 21 publications

References 20 publications

An international survey of SEEG cortical stimulation practices

An international survey of SEEG cortical stimulation practices

Epilepsy centers in China: Current status and ways forward

Outcomes of resective surgery in pediatric patients with drug‐resistant epilepsy: A single‐center study from the Eastern Mediterranean Region

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