Epilepsy and Its surgical management in LMICs, Where are we standing? The scenario, scope and challenges
EANS Academy. Maria N. 10/04/21; 339100; EP08011
Abstract
Background: While epilepsy surgery is a promising option for drug-resistant epilepsy, it is still an underrated and underutilized procedure worldwide especiall in the low-middle income countries where there is also a higher incidence and prevalence of epilepsy
Methodology: We reviewed articles and performed survey to know the availability and scope of epilepsy surgery and specialty training in LMIC.
Results: According to WHO epilepsy surgery is available in only 13% of LMIC. In LMIC,73.3- 75% of patients do not receive any treatment and the number of surgeries is extremely sparse.LatinAmerica and western sub-Saharan Africa it is 21st and 14th cause of DALYs respectively. Epilepsy can even be prevented by proper perinatal care, law enforcement to prevent head injuries and treating CNS infections in time. A Tanzanias study showed association of adverse perinatal events with epilepsy (OR 14.9, 95% CI 1.4–151.3)In Pakistan there is only one epilepsy surgery center at the AKU, no national guidelines for epilepsy management and no national training program for epilepsy surgery. Vietnam,Indonesia and Thailand has at least one level-4 epilepsy care facility. 39 epilepsy centers in India .In Bangladesh, epilepsy surgery is developing appreciably. In our survey 10% neurosurgeons admitted to have observed epilepsy surgery, commonest surgery was anterior temporal lobectomy, 25% had epilepsy surgery performed in their country, 60% were interested in it, 30% had at least 1 dedicated epilepsy center in their country, only 20% had a national training program .The challenges for epilepsy surgery, all agreed that it is because of lack of trained personnel, 70% agreed that their hospitals are not well equipped ,70% no training program, 60% mentioned cost of surgery is a challenge in their countries.
Conclusion: With our survey and literature review, we conclude that epilepsy surgery is still an under rated management strategy in the LMIC for epileptic patients.
Methodology: We reviewed articles and performed survey to know the availability and scope of epilepsy surgery and specialty training in LMIC.
Results: According to WHO epilepsy surgery is available in only 13% of LMIC. In LMIC,73.3- 75% of patients do not receive any treatment and the number of surgeries is extremely sparse.LatinAmerica and western sub-Saharan Africa it is 21st and 14th cause of DALYs respectively. Epilepsy can even be prevented by proper perinatal care, law enforcement to prevent head injuries and treating CNS infections in time. A Tanzanias study showed association of adverse perinatal events with epilepsy (OR 14.9, 95% CI 1.4–151.3)In Pakistan there is only one epilepsy surgery center at the AKU, no national guidelines for epilepsy management and no national training program for epilepsy surgery. Vietnam,Indonesia and Thailand has at least one level-4 epilepsy care facility. 39 epilepsy centers in India .In Bangladesh, epilepsy surgery is developing appreciably. In our survey 10% neurosurgeons admitted to have observed epilepsy surgery, commonest surgery was anterior temporal lobectomy, 25% had epilepsy surgery performed in their country, 60% were interested in it, 30% had at least 1 dedicated epilepsy center in their country, only 20% had a national training program .The challenges for epilepsy surgery, all agreed that it is because of lack of trained personnel, 70% agreed that their hospitals are not well equipped ,70% no training program, 60% mentioned cost of surgery is a challenge in their countries.
Conclusion: With our survey and literature review, we conclude that epilepsy surgery is still an under rated management strategy in the LMIC for epileptic patients.
Background: While epilepsy surgery is a promising option for drug-resistant epilepsy, it is still an underrated and underutilized procedure worldwide especiall in the low-middle income countries where there is also a higher incidence and prevalence of epilepsy
Methodology: We reviewed articles and performed survey to know the availability and scope of epilepsy surgery and specialty training in LMIC.
Results: According to WHO epilepsy surgery is available in only 13% of LMIC. In LMIC,73.3- 75% of patients do not receive any treatment and the number of surgeries is extremely sparse.LatinAmerica and western sub-Saharan Africa it is 21st and 14th cause of DALYs respectively. Epilepsy can even be prevented by proper perinatal care, law enforcement to prevent head injuries and treating CNS infections in time. A Tanzanias study showed association of adverse perinatal events with epilepsy (OR 14.9, 95% CI 1.4–151.3)In Pakistan there is only one epilepsy surgery center at the AKU, no national guidelines for epilepsy management and no national training program for epilepsy surgery. Vietnam,Indonesia and Thailand has at least one level-4 epilepsy care facility. 39 epilepsy centers in India .In Bangladesh, epilepsy surgery is developing appreciably. In our survey 10% neurosurgeons admitted to have observed epilepsy surgery, commonest surgery was anterior temporal lobectomy, 25% had epilepsy surgery performed in their country, 60% were interested in it, 30% had at least 1 dedicated epilepsy center in their country, only 20% had a national training program .The challenges for epilepsy surgery, all agreed that it is because of lack of trained personnel, 70% agreed that their hospitals are not well equipped ,70% no training program, 60% mentioned cost of surgery is a challenge in their countries.
Conclusion: With our survey and literature review, we conclude that epilepsy surgery is still an under rated management strategy in the LMIC for epileptic patients.
Methodology: We reviewed articles and performed survey to know the availability and scope of epilepsy surgery and specialty training in LMIC.
Results: According to WHO epilepsy surgery is available in only 13% of LMIC. In LMIC,73.3- 75% of patients do not receive any treatment and the number of surgeries is extremely sparse.LatinAmerica and western sub-Saharan Africa it is 21st and 14th cause of DALYs respectively. Epilepsy can even be prevented by proper perinatal care, law enforcement to prevent head injuries and treating CNS infections in time. A Tanzanias study showed association of adverse perinatal events with epilepsy (OR 14.9, 95% CI 1.4–151.3)In Pakistan there is only one epilepsy surgery center at the AKU, no national guidelines for epilepsy management and no national training program for epilepsy surgery. Vietnam,Indonesia and Thailand has at least one level-4 epilepsy care facility. 39 epilepsy centers in India .In Bangladesh, epilepsy surgery is developing appreciably. In our survey 10% neurosurgeons admitted to have observed epilepsy surgery, commonest surgery was anterior temporal lobectomy, 25% had epilepsy surgery performed in their country, 60% were interested in it, 30% had at least 1 dedicated epilepsy center in their country, only 20% had a national training program .The challenges for epilepsy surgery, all agreed that it is because of lack of trained personnel, 70% agreed that their hospitals are not well equipped ,70% no training program, 60% mentioned cost of surgery is a challenge in their countries.
Conclusion: With our survey and literature review, we conclude that epilepsy surgery is still an under rated management strategy in the LMIC for epileptic patients.
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