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Lesional epilepsy surgery in brain mapping era (overcoming challenges in developing countries)
EANS Academy. Morsy A. Sep 26, 2019; 276172; EP07042
Ahmed Morsy
Ahmed Morsy

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Purpose: Neurosurgery is an underutilized treatment that can potentially cure drug‐refractory epilepsy. Careful, multidisciplinary presurgical evaluation is vital for selecting patients and to ensure optimal outcomes. Resective epilepsy surgery is currently a standard treatment for intractable focal lesional epilepsy.
We review our experience in lesional epilepsy surgery using recent pre and intraoperative brain mapping techniques for ensuring satisfactory resection of such lesions at Zagazig University Hospitals, Egypt.
Materials and methods: We performed a 2-years review of patients (n=60) with a diagnosis of intractable focal epilepsy, with MRI lesions, who underwent epilepsy surgery and were followed up for at least 2 years, and were evaluated for postoperative outcome. Pre-operative comprehensive neuropsychological and radiological evaluation was performed by multidisciplinary epilepsy team. Intraoperative brain mapping techniques including awake craniotomy and direct stimulation techniques and neurophysiological monitoring were carried out during surgical resection. Operative complications, neurological deficits, and extent of resection were evaluated. Engel class I-IV classification was the primary outcome measure of epilepsy surgery.
Results: There were 32 male and 28 female patients with a mean age of 25.6 years. There were no major anesthetic complications. 6 patients (10%) had intra-operative seizures. Postoperative neurological deficit was seen in 10 patients (16.7%) and this was permanent in only 4 patients (6.7%). The success rate as Engel class I was 83.3%, 6 patients (10%) showed Engel class II and III, while 4 patients (6.67%) showed no worthwhile improvement as Engel class VI.
Conclusion: We found favorable outcomes after surgery in lesional epilepsy patients especially with using brain mapping techniques; so we believe that it is a major treatment option, even in less resource intensive settings, and should be encouraged. Dissemination of such knowledge and improving infrastructure may be considered an urgent clinical need especially in developing countries.
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