Resective epilepsy surgery in a limited-resource settings: A cohort from a multi-disciplinary epilepsy team in a developing country

Hussein Hamdi; Nirmeen Kishk; Reham Shamloul; Mona K Moawad; Micheal Baghdadi; Mina Rizkallah; Amani Nawito; Mohammad Edrees Mohammad; Hatem Nazmi; Yasser Mohamed Nasr; Salwa Hassan Waly; Mo'men Elshahat; Rehab Magdy; Alshimaa S Othman; Hesham Nafea; Amro M Fouad; Ismail Elantably; Haytham Rizk; Enas Elsayyad; Ahmed A Morsy

doi:10.25259/SNI_1081_2022

Resective epilepsy surgery in a limited-resource settings: A cohort from a multi-disciplinary epilepsy team in a developing country

Surg Neurol Int. 2023 Jul 14:14:240. doi: 10.25259/SNI_1081_2022. eCollection 2023.

Authors

Hussein Hamdi¹, Nirmeen Kishk², Reham Shamloul², Mona K Moawad², Micheal Baghdadi³, Mina Rizkallah³, Amani Nawito⁴, Mohammad Edrees Mohammad², Hatem Nazmi⁵, Yasser Mohamed Nasr⁵, Salwa Hassan Waly⁵, Mo'men Elshahat⁶, Rehab Magdy², Alshimaa S Othman², Hesham Nafea⁴, Amro M Fouad², Ismail Elantably⁶, Haytham Rizk², Enas Elsayyad², Ahmed A Morsy⁶

Affiliations

¹ Department of Neurosurgery, Faculty of Medicine, Tanta University, Tanta, Egypt.
² Department of Neurology, Faculty of Medicine, Cairo University, Cairo, Egypt.
³ Department of Radiology, Ministry of Health, Cairo, Egypt.
⁴ Department of Clinical Neurophysiology, Faculty of Medicine, Cairo University, Cairo, Egypt.
⁵ Department of Anesthesia, Surgical Intensive Care and Pain Management, Zagazig, Egypt.
⁶ Department of Neurosurgery, Faculty of Medicine, Zagazig University, Zagazig, Egypt.

Abstract

Background: Multidisciplinary pre-surgical evaluation is vital for epilepsy surgery decision and outcomes. Resective epilepsy surgery with assisted monitoring is currently a standard treatment for focal drug resistant epilepsy (DRE). In resource-limited countries, lack of epilepsy surgery center is a huge challenge. We presented and illustrated how to create a multidisciplinary protocol with resource-limited settings in a developing country and epilepsy surgery outcome using brain mapping and monitoring techniques for ensuring satisfactory resection.

Methods: We created multicentric incomplete but complementary units covering all epilepsy-related sub-specialties and covering a wide geographical area in our country. Then, we conducted a prospective and multicentric study with low resource settings on patients with focal DRE, who underwent resective epilepsy surgery and were followed up for at least 12 months and were evaluated for postoperative seizure outcome and complications if present. Preoperative comprehensive clinical, neurophysiological, neuropsychological, and radiological evaluations were performed by multidisciplinary epilepsy team. Intraoperative brain mapping including awake craniotomy and direct stimulation techniques, neurophysiological monitoring, and electrocorticography was carried out during surgical resection.

Results: The study included 47 patients (18 females and 29 males) with mean age 20.4 ± 10.02 years. Twenty-two (46.8%) patients were temporal epilepsy while 25 (53.2%) were extra-temporal epilepsy. The epilepsy surgery outcome at the last follow up was Engel Class I (seizure free) in 35 (74.5%), Class II (almost seizure free) in 8 (17%), Class III (worthwhile improvement) in 3 (6.4%), and Class IV (no worthwhile improvement) in 1 patient (2.1%).

Conclusion: With low resource settings and lack of single fully equipped epilepsy center, favorable outcomes after resective surgery in patients with focal DRE could be achieved using careful presurgical multidisciplinary selection, especially with using intraoperative brain mapping and electrocorticography techniques.

Keywords: Developing country; ECoG; Epilepsy; Resective; Surgery.